GLOSSARY MEDICAL TERMS 2011 by RONDA NEWS

Glossary

Ubipedia by Ubald Schmid, February 2011 1

a abduction The movement of a limb away from the midline of the body, e.g., abduction at the shoulder moves the arm away from the trunk and out to the side. At the thumb, it describes movement of the digit forward from the anatomical position, away from the palm abrasion An abrasion is a wearing away of the surface of a material as a result of applied friction force abbreviated injury scale (AIS) is an anatomically based consensus‐derived global severity scoring system that classifies each injury in every body region according to its relative severity on a six point ordinal scale: 1 Minor, 2 Moderate, 3 Serious, 4 Severe, 5 Critical, 6 Maximal (currently untreatable) abscess A localized collection of pus in a cavity, surrounded by inflamed tissue absolute stability Complete absence of displacement between fracture surfaces. The compressed surfaces of the fracture do not displace under applied functional load. The fracture heals without callus formation = primary or direct bone healing. Opposite: relative stability access In general, a means the way of approaching something adduction Movement of a part towards the midline, e.g., adduction at the hip joint moves the leg toward the midline and adduction of both legs would press the knees together or cross the legs adhesions Tissue structures normally separated that adhere together because of inflammation or injury adipocyte Fat cell. A connective tissue cell that has differentiated and become specialized in the synthesis and storage of fat. The adipocyte is important to the body in maintaining proper energy balance, storing calories in the form of lipids (fat), mobilizing energy sources in response to hormonal stimulation, and commanding changes by signal secretions aetiology The study of the causes. For example, of a disorder

agonist An agonist produces an action, e.g. a flexor flexes an extremity. The opposite is an antagonist which acts against and blocks an action, e.g. the extensor extends the extremity AIS See abbreviated Injury scale and injury severity score algodystrophy See fracture disease allograft Graft of tissue from another individual of the same species, who is genetically different from the recipient. Bone is generally transplanted without revascularization. Histocompatibility studies, essential in organ transplantation, are not necessary in bone allografting anaerobic Those metabolic processes which are not dependent on oxygen. Anaerobic organisms can, therefore, thrive in tissues which are hypoxic or anoxic anaesthesia See anaesthesia Loss of feeling or awareness. A general anaesthesia puts the person to sleep. A local anesthetic causes loss of feeling in a part of the body without affecting consciousness anaphylaxis is an allergic condition in which the cardiac output and arterial pressure often fall drastically causing anaphylactic shock. Such a reaction is detrimental to the circulatory system in several important ways anastomosis A junction between two vessels or other tubular anatomical structures anatomical position the body is assumed to be standing, the feet together, the arms to the side, and the head and eyes and palms of the hands facing forwards anatomical reduction The exact adaptation of fracture fragments (hairline adjustment). It will result in complete restoration of the normal anatomy. While overall stability does not depend on precise reduction, precise reduction more reliably results in stability and increased strength of fixation. It is more important in articular fractures than in diaphyseal fractures. See also stability 3

anatomy Anatomy is the science that studies the structure of the body. Gross anatomy involves structures that can be seen with the naked eye. It is as opposed to microscopic anatomy (or histology) which involves structures seen under the microscope anesthesia See anaesthesia aneurysm or aneurism is a localized, blood‐filled balloon‐like bulge in the wall of a blood vessel angular stability The property of an implant for fracture stabilisation, which is designed in such a way that the discreet parts of the implant, when assembled, are fixed in their angular relationship to each other. Usually applied to plates and screws, when the screw heads, once driven home in the plate hole, bind to the plate ‐ this is achieved by an external thread on the screw head which engages with an internal thread in the plate hole. This principle was first described in 1935 by Rheinhold (France) angulation The orientation of one body (e.g., bone fragment) in such a manner that the two parts meet at an angle rather than a straight line. The standard surgical convention is that the angulation is characterized by describing the deviation of the distal part from its anatomical position. For example, at a Colles’’ fracture, the distal radial fragment is dorsally (or posteriorly) angulated, even though the apex of the deformity points anteriorly; similarly a tibial fracture whose apex angulation points backward should be referred to as angulated anteriorly, as the distal part is indeed angulated anteriorly from its anatomical position ankle sprain A common musculoskeletal injury in which the ligaments of the ankle partially or completely tear due to sudden stretching. This typically occurs when the ankle is suddenly "twisted" in a sports activity or by stepping off an uneven surface ankylosis Fusion of a joint by bone or a tight fibrous union, occurring spontaneously as a result of a disease process, e.g., following septic arthritis (pyarthrosis) anodization A finish achieved by immersing a metal into an acid solution and passing a direct current through the material. This forms a durable oxide film on the surface which increases resistance to corrosion and results in colour variations by light disfraction antagonist Physiology: a muscle that acts in opposition to another. Compare agonist See Illustration agonist anterior The front aspect of the body in the anatomical position. If A is in front of B in the anatomical position, then A is said to be anterior to B. See Illustration directions 4

antegrade Moving forward or extending forward. Opposite: retrograde Illustration: antegrade insertion of a nail antibiotic Any drug, such as penicillin, produced by certain fungi, bacteria, and other organisms, which can inhibit the growth of, or destroy, microorganisms. They are used for the prevention or treatment of infections antibody A substance produced by the host’s immune system, in response to the detection of an antigen. The antibody is specifically elaborated to attack and destroy only the antigen which stimulated its production—antigen specific antigen Component of a foreign biological substance (transplanted tissue, invading virus, etc.), which stimulates the host’s immune system to attack that foreign substance by elaborating antibodies which destroy the antigen and in so doing may result in damage to the “invader” antiseptic Originally the surgical strategy for avoiding postoperative sepsis by applying to the wound bactericidal chemicals, as in the carbolic acid aerosol described and used by Joseph Lister in the late 19th century ‐ the era of antiseptic surgery. Now a term used for non‐biological chemicals which have topical bactericidal properties AP‐view X‐ray projection from anterior to posterior apex From the Latin meaning summit, the apex is the tip (or peak) of a pyramidal or rounded structure 5

ARDS Acute Respiratory Distress Syndrome. A fulminant lung condition in which trauma to the lungs leads to inflammation of the lungs, accumulation of fluid in the alveolar air sacs, low blood oxygen, and respiratory distress arthritis Inflammation of a joint. When joints are inflamed they can develop deformities, stiffness, warmth, swelling, redness and pain arthrodesis fusion of a joint by bone, as a planned outcome of a surgical procedure arthropathy Any joint disease arthroplasty Joint replacement. A joint replacement is needed when an arthrotic or damaged joint is removed and replaced with an artificial joint, called prosthesis arthroscopy is a term used to described examining the inside of a joint using a lighted, flexible instrument called an endoscope 6

arthrosis This is a condition which affects synovial joints and is characterized by loss of articular cartilage, reactive subchondral bone sclerosis (sometimes with subchondral cysts), and the formation of peripheral bony outgrowths ‐ osteophytes. The primary lesion is degeneration of the articular cartilage as a consequence of infection, trauma, overuse, congenital skeletal anomaly, or as part of the aging process. The expression “osteoarthritis” which is very often used instead of arthrosis is actually not correct articular fracture ‐ partial Only part of the joint is involved while the remainder remains attached to the diaphysis. Require anatomical reduction and fixation with absolute stability. articular fracture ‐ complete The entire articular surface is separated from the diaphysis. Require anatomical reduction and fixation with absolute stability. Complete articular fractures are also called intra‐articular fractures articulate To join together loosely to allow motion between the parts (bones) aseptic Free of microorganisms capable of causing infection aspiration Removal of fluids from a cavity or, the accidental breathing of fluids or solids into the lungs atrophic non‐union If a fracture fails to heal because the biological responses leading to bony union are frustrated, usually due to adverse biological status of the fracture locus, the non‐union is categorised as atrophic, with absence of callus, rounding off of the bone ends and finally may result in the formation of a false joint, or pseudarthrosis atrophy Decrease in size or wasting away of a body part or tissue augmentation See bone augmentation autoclave A chamber for sterilizing with steam under pressure autogenous Originating or derived from sources within the same individual autograft (homograft). Graft of tissue from one site to another within the same individual avascular Without blood vessels avascular necrosis (often abbreviated as AVN): Bone which has been deprived of its blood supply dies. In the absence of sepsis, this is called avascular necrosis (aseptic necrosis). The dead bone retains its normal strength until the natural process of revascularization by “creeping substitution”—see blood supply—starts to remove the dead bone, in preparation for the laying down of new bone. Loaded areas may then collapse—segmental collapse. This occurs in the femoral head and the talus more frequently than at other skeletal sites 7

AVN See avascular necrosis avulsion fracture Avulsion fractures are caused by a tendon or a ligament dislodging a bone fragment axial Viewed along main axis of the body. i.e. cross‐sectional view Illustration: axial MRI of the proximal humerus

b bacteria are a large group of single‐celled microorganisms bactericidal Capable of killing bacteria Bado classification Classification for Monteggia fractures into 4 different types 8

Barton’s fracture is an intra‐articular fracture of the distal radius with dorsal displacement or dislocation of the radiocarpal joint (intra‐articular Colles’ fracture) See also Smith’s fracture and reversed Barton’s fracture benign Not cancer. Not malignant. A benign tumor does not invade surrounding tissue or spread to other parts of the body. A benign tumor may grow but it stays put (in the same place) Bennett’s fracture Fracture of the base of the thumb metacarpal ß‐Tricalcium phosphate Mineral compound that is frequently used as a bone graft substitute bilateral Occurring on both sides of the midline biocompatibility The ability to exist in harmony with, and not to injure, associated biological tissues or processes biological bone healing Bone healing with callus formation under conditions of relative stability. See: indirect bone healing See illustration callus biological fixation utilizes a surgical exposure technique which favors the preservation of the blood supply, and thereby optimizes the healing potential, of the bone and soft tissues, whilst providing sufficient stability for multifragmentary fractures to heal in correct length alignment and rotation. See also flexible fixation biopsy The surgical removal of a piece of tissue for histological examination, usually undertaken to establish a diagnosis blast Immature cell

blood supply to cortical bone: Cortical bone which has been completely deprived of its blood supply for any extended period of time dies. It may become revascularized either by ingrowth of blood vessels without marked widening of the longitudinal Haversian canals, or by newly formed Haversian canals which result from the penetration of osteons. Another source of blood supply are channels running perpendicular to haversian canals (Volkmann’s canals), allowing blood vessels to travel from osteon to osteon. Such osteonal remodeling is a process with a marked lag period and a slow speed (0.1 mm/day according to Schenk). When aseptic necrotic bone is revascularized by resorption and replacement with newly formed, vascular bone, the term creeping substitution is often applied body planes coronal A coronal plane is any plane of section in the anatomical position that passes vertically through the body and is perpendicular to the median plane passing from side to side. It divides the body into anterior and posterior sections frontal Pertaining to the front of the body in the anatomical position. The frontal plane of the body, parallel to the front, is the same as the coronal plane horizontal Parallel with the horizon (see also transverse median body plane Sagittal body plane, dividing the body into a right and a left half sagittal A vertical plane passing through the standing body from front to back. The mid‐sagittal, or median, plane splits the body into left and right halves transverse Perpendicular to the long axis of bone. Not the same as horizontal, which means parallel with the horizon. Thus, if the body were lying flat on its back (supine), horizontal would be the same as the coronal plane (see above), but if the body were standing, in the anatomical position, horizontal would be in the transverse plane. In other words, horizontal is always related to the horizon, whereas the anatomical planes (coronal, frontal, sagittal, transverse) always relate to the anatomical position bone cells provide osteogenesis. The direct transplantation of living bone cells work as seeding in the growth process. They induce immediate growth inside the material => enable bone growth both from the outside‐and‐in and inside‐and‐out. 10

bone augmentation is a term that is used to describe a variety of procedures that are used to "build" bone so that implants get (better) hold in the bone. These procedures typically involve grafting (adding) bone or bonelike, synthetic materials bone cyst A solitary benign fluid‐filled cyst (cavity) in a bone, usually in the shaft of a long bone, especially the humerus, in children. The cyst can cause pain in or near it. Also called a unicameral bone cyst or solitary bone cyst. The cause of the lesion is unknown bone densitometry A procedure used to detect osteopenia or osteoporosis in which a special density gradient plate is used to evaluate the comparative density of the spine, femur, or distal radius. Photons from a single‐ or dual‐emitting source are used to measure the density of the bone. These are then compared with normal values for a large patient population based on sex and age. See also DEXA‐scan See illustration dexa scan bone graft Bone removed from one skeletal site and placed at another. Bone grafts are used to stimulate bone union and also to restore skeletal continuity where there has been bone loss. See allograft, autograft, and xenograft bone lining cell Bone cells derived from osteoblasts that cover the surface of resting bone. These cells regulate calcium release from bone and initiate remodeling bone marrow can be found in almost any bone that holds cancellous tissue. In newborns, all such bones are filled exclusively with red marrow, but as the child ages it is mostly replaced by yellow, or fatty marrow. In adults, red marrow is mostly found in the marrow bones sternum, the ribs, the vertebrae and pelvic bones bone marrow aspiration Bone marrow surgically removed from within the bone bone morphogenic proteins (BMPs) provide osteoinduction. Work as a fertilizer for the growth process. They induce growth inside the bone => enable bone growth both from the outside‐and‐in and inside‐and‐out BMPs boxer’s fracture Fracture of the fifth metacarpal head with volar angulation. Usually seen due to punching a wall or hard object

brachial pertaining to the arm bridge plate Is a plate bridging a fracture, providing relative stability broad spectrum Refers to antibiotics which are active against a wide range of different organisms bunion A bunion is a localized painful swelling at the base of the big toe (the great toe). The joint is enlarged (due to new bone formation) and the toe is often misaligned. It is frequently associated with inflammation. It can be related to inflammation of the nearby bursa (bursitis) or degenerative joint disease (osteoarthritis) bursa A closed fluid‐filled sac formed by two layers of synovial tissue that functions to provide a gliding surface to reduce friction between tendon and bone or skin and bone Illustration: bursae shoulder butterfly fragment A third fragment of a fracture which does not comprise a full cross section of the bone (i.e., after reduction there is some contact between the two main fragments), the small wedge‐shaped fragment, which may be spiral, is occasionally referred to as wedge fracture Illustration: Fracture AO classification type B 12

buttress An implant applied in such a manner as to press against a fragment and prevent its axial displacement under compressive physiological load, maintaining its reduction “out to length”, is said to be functioning as a buttress. An example would be a contoured plate applied to the proximal end of the tibia to prop up the surgically elevated main articular fragment of a tibial plateau fracture, thereby preventing its redisplacement into a position of depression Illustration: Buttress plate

c calcification The deposition of calcium salts within a tissue or structure calcium sulphate A salt that has been used since the 1890’s as a bone graft substitute callus A tissue complex formed at a site of bony repair. Bony callus is part of the bone repair process. Following a fracture it makes a gradual and progressive transition through a series of tissue types ‐ hematoma ‐ granulation tissue ‐ fibrous tissue (or fibrocartilagenous tissue) ‐ calcified tissue ‐ remodeling into woven bone, gaining in stiffness as it does so. Callus is welcome as a repair tissue in all treatment methods where relative fracture stability has been the planned goal. See also relative stability canaliculi are microscopic canals between the various lacunae of ossified bone. The radiating processes of the osteocytes project into these canals cancellous bone Cancellous bone, synonymous with trabecular bone or spongy bone, is one of two types of osseous tissue that form bones. Compared to compact bone (cortex or cortical bone), which is the other type of osseous tissue, it has a higher surface area but is less dense, softer, weaker, and less stiff. It typically occurs at the ends of long bones, proximal to joints and within the interior of vertebrae. Cancellous bone is highly vascular and frequently contains red bone marrow where hematopoiesis, the production of blood cells, occurs. The primary anatomical and functional unit of cancellous bone is the trabecula 13

c‐arm For intraoperative x‐ray control. An imaging device that uses x‐rays to view structures in the body in real time. Also called fluoroscope or image intensifier capsule A membrane that encloses a joint to form a closed joint cavity carpal tunnel syndrome (CTS) Median nerve compression at the wrist in the carpal tunnel (the fibro‐osseous passageway on the palmar side), that is characterized by pain, numbness, and weakness in the median nerve distribution of the hand. The pathophysiology is not completely understood carrier An inactive substance used to aid in the delivery of an active substance cartilage A cellular tissue that, in the adult, is specific to joints, but in children forms a template (epiphysis or growth plate) for bone formation and growth. Hyaline cartilage is a low‐friction cellular, avascular tissue that coats joint surfaces. Fibrocartilage is tough with high collagen content, such as found in the meniscus of the knee, or the annulus fibrosus portion of the intervertebral disk CAT See CT‐scan caudad Literally "tailward". If A is nearer to the "tail", or coccyx, than B, then A is caudad of B. The opposite is cephalad See illustration Directions “caudal” caudal An anatomic term meaning 1. Pertaining to the tail or the hind part. 2. Situated in or directed toward the tail or hind part. 3. Inferior to another structure, in the sense of being below it See illustration directions 14

cell The basic subunit of any living organism; the simplest unit that can exist as an independent living cephalad Literally “headward”. If A is nearer to the head than B, then A is cephalad of B. Usually confined to the axial, rather than the appendicular, structures. The opposite is caudad See illustration directions “cranial” cervical Having to do with any kind of neck including the neck on which the head is perched chauffeur’s fracture Oblique fracture of the radial styloid caused by a twisting or snapping type injury chemotherapy Treatment of malignant lesions with drugs that impair, or stop, their cellular proliferation chondral Pertaining to cartilage. Consisting of cartilage chondroblasts The cells that build up cartilage chondrocytes The active cells of all cartilage, whether articular cartilage, growth cartilage, fibrocartilage, etc. They produce the chondral matrix, both its collagen and the mucopolysaccharides of the ground substance chondromalacia Softening of the articular surface that results from exposure of normal cartilage to excessive pressure or shear chronic obstructive lung disease (COLD) Any disorder that persistently obstructs bronchial airflow. COLD mainly involves two related diseases ‐‐ chronic bronchitis and emphysema. Both cause chronic obstruction of air flowing through the airways and in and out of the lungs. The obstruction is generally permanent and progresses over time circumflex Arc of a circle; winding around Illustration: anterior humeral circumflex artery

closed reduction Conservative fracture treatment. Cave: sometimes the indirect, minimal invasive reduction is also called closed reduction co‐morbid Pertaining to two or more disorders simultaneously collagen is the principal structural protein of the skin, tendons, cartilage, bone and connective tissue Colles’ fracture is a distal extra‐articular fracture of the radius in the forearm with dorsal (posterior) displacement or dislocation of the wrist and hand; often caused by a fall on an outstretched arm with the hand extended. See also Smith’s fracture, Barton’s fracture and reversed Barton’s fracture comminuted fractures have more than 2 bone fragments. Comminuted fractures include segmental fractures (2 separate breaks in a bone). The term comminuted is imprecise and should not be used. The better term is complex fractures compartment syndrome The compartment syndrome is an acute medical problem following injury, surgery or in most cases repetitive and extensive muscle use, in which increased pressure within a confined space (fascial compartment) The elevated pressure leads to ischemia of the nerves and muscles and results in potential tissue necrosis within the compartment. Frequently seen in association with tibial fractures. See muscle compartment See illustration muscle compartment complex fracture A fracture with one or more intermediate fragment(s) in which, after reduction, there is no contact between the main proximal and distal fragments. The complex fractures are spiral, segmental or irregular. The term comminuted fracture is imprecise and should not be used Illustration: Fracture AO classification type compound fracture A fracture in which the bone is sticking through the skin. Also called open fracture compression The act of pressing together. It results in deformation (shortening like a spring) and improvement or creation of stability. Compression is used to provide absolute stability of fixation where motion induced resorption must be prevented, and to protect the implants and to improve their efficiency by unloading them. Unloading is achieved through restoration of the load‐bearing capacity of the bone compression fracture Collapse of (mostly cancellous) bone often due to axial impacts or osteoporosis Illustration: Compression fracture tibia plateau type Schatzker II 16

compression plate Is a plate allowing interfragmentary compression compression screw See lag screw computed tomography See CT scan concave Hollowed or rounded inward resembling the inside of a bowl Illustration: Concave joint surface of distal radius congenital Present at birth. A condition that is congenital is one that is present at birth. There are numerous uses of "congenital" in medicine. There are, for example, congenital abnormalities connective tissue is a form of fibrous tissue that connects and supports the structures of the body. It is one of the four types of tissue in traditional classifications (the others being epithelial, muscle, and nervous tissue) contact healing occurs between two fragment ends of a fractured bone in motionless contact. The fracture is then repaired by direct internal remodeling. Contact healing may be observed additionally where the gap is only a few micrometers wide contraindication A condition which makes a particular treatment or procedure inadvisable. A contraindication may be absolute or relative contralateral Originating in, or affecting the opposite side of the body convex Curved or rounded, resembling the exterior of a sphere or circle Illustration: Convex joint surface of talus coronal plane A coronal plane is any plane of section in the anatomical position that passes vertically through the body and is perpendicular to the median plane passing from side to side. It divides the body into anterior and posterior sections See illustration Body planes corrosion Determines how much “metal” is released into the surrounding tissue cortex See cortical bone

cortical bone The dense bone forming the tubular element of the shaft (diaphysis of a long bone). The term is also applied to the dense, thin shell covering the cancellous bone of the metaphysis. The term is generally used interchangeably with cortex corticotomy A special osteotomy where the cortex is surgically divided but the endosteum and the medullary content are not injured coxarthrosis Degenerative arthrosis (osteoarthritis) of the hip joint C.P.M. Continuous passive motion: The use of apparatus to move a joint through a controlled range of motion has been shown to enhance articular cartilage healing after injury and to promoted soft tissue recovery after surgery cranial Adjective related to the cranium (skull); towards the head See illustration directions creeping substitution The process by which osteoclasts and osteoblasts remove old, necrotic bony tissue and replace it with new bone (remodeling). See also blood supply crest Prominent ridge on a bone Creutzfeldt‐Jakob disease (CJD), A transmissible degenerative brain disorder technically termed spongiform encephalopathy. Eating "mad cow" meat can lead to Creuzfeldt‐Jakob‐ like disease, a dementing disease of the brain. It is believed due to an unconventional, transmissible agent (a prion). Symptoms of CJD include forgetfulness, nervousness, jerky trembling hand movements, unsteady gait, muscle spasms, chronic dementia, balance disorder, and loss of facial expression. CJD is classified as a spongiform encephalopathy. There is neither treatment nor cure for CJD. Other names for CJD include Creutzfeldt‐Jakob syndrome, Jakob's disease, and spastic pseudoparalysis

crush injury A crush injury occurs when a body part is subjected to a high degree of force or pressure, usually by being squeezed between two heavy objects. Usually extremity are affected CT‐scan formerly CAT scan (computerized axial tomography). CT‐scan is a radiographic modality that allows cross‐sectional imaging from a series of x‐ray beams. The x‐ray tube is rotated 360° around the patient, and the computer converts these images into a two‐dimensional axial image. CT is capable of imaging bone in three planes: coronal, sagittal, and transverse. This modality is particularly useful in evaluating fractures and bone tumors Illustration: Transverse scan through tibia and fibula shaft curettage is the removal of growths from within cavity walls; in the treatment of musculoskeletal tumors, the scraping of tumor out of bone cutting cone Procession of osteoclasts and osteoblasts tunnelling through cortical bone. Osteoclasts resorb bone while osteoblasts follow behind and lay down osteoid in their wake. Cutting cones are passing the fracture under conditions of absolute stability cyst A cyst is an abnormal, closed sac‐like structure within a tissue that contains a liquid, gaseous, or semisolid substance. A cyst can occur anywhere in the body and can vary in size. The outer, or capsular, portion of a cyst is termed the cyst wall Illustration: Juvenile cyst in humeral shaft cytoplasm is the part of the cell between the cell nucleus membrane and the nuclear envelope. It is the jelly‐ like substance in a cell that contains the cytosol, organelles, and inclusions, but not including the nucleus cytoplasm

d DBM Demineralized bone matrix. Demineralized allograft bone with osteoinductive activity. Demineralized bone matrices are prepared by acid extraction of allograft bone, resulting in loss of most of the mineralized component but retention of collagen and non‐collagenous proteins, including growth factors debridement is the act or process of removing dead, contaminated or adherent tissue or foreign material. Debridement encompasses enzymatic debridement (as with proteolytic enzymes), mechanical non selective debridement (as in a whirlpool), and sharp debridement (by surgery) decubitus (lateralis) Lying on the side deformity Any abnormality of the form of a body part. The standard surgical convention is that the deformity is characterised by describing the deviation of the distal part from its anatomical position. Certain deformities have specific names – see varus, recurvatum etc. degenerative joint disease (DJD) Deterioration of the articular cartilage that lines a joint, which results in narrowing of the joint space and pain; arthrosis degeneration a process by which a tissue deteriorates, loses functional activity, and may become converted into or replaced by other kinds of tissue delayed union Failure of a fracture to consolidate within the normally expected time, which varies according to fracture type and location. Delayed union, like union, is a surgical judgment and cannot be allocated a specific time period demineralized bone. Bone from which most of the mineral content has been removed by a chemical process. See DBM dexa scan Dexa stands for ‘Dual Energy X‐ray Absorptiometry’. It is the most commonly used test for measuring bone mineral density. It is one of the most accurate ways to diagnosis osteopenia or osteoporosis. See also bone densitometry

diabetes mellitus is a group of metabolic diseases characterized by high blood sugar (glucose) levels, that result from defects in insulin secretion, or action, or both. Diabetes mellitus commonly referred to as diabetes diagnosis The act or process of identifying or determining the nature and cause of a disease or injury through evaluation of patient history, examination, and review of laboratory data diaphysis The cylindrical, or tubular part between the ends of a long bone, often referred to as the shaft See illustration metaphysis diastasis Separation of parts of the body that are normally joined together, such as the separation of adjacent bones without fracture direct bone healing: Also called Haversian remodeling. A type of fracture healing observed with absolutely stable (rigid) internal fixation. It is characterized by: 1. Absence of callus formation specific to the fracture site. 2. Absence of bone surface resorption at the fracture site. 3. Direct bone formation, without any intermediate repair tissue. Direct fracture healing was formerly called “primary” healing, a term avoided today so as not to imply any grading of the quality of fracture healing. Two types of direct healing are distinguished, namely contact healing and gap healing Illustration: Direct bone healing – osteons crossing the fracture line direct ossification See direct bone healing and osteogenesis

directions

direct reduction The term direct reduction implies that the fracture area is exposed surgically or is already widely open. The fragments are grasped by surgical instruments and preferably not by hand. Reduction of the fracture fragments is achieved by applying forces and moments directed to the vicinity of the fracture zone. In simple diaphyseal fracture patterns (whenever treated with a plate – standard treatment is nailing), direct reduction is technically straightforward and the result easy to control. The fracture is exposed, anatomically reduced and fixed with absolute stability. Direct reduction is principally indicated in articular fractures disease The term disease broadly refers to any abnormal condition that impairs normal function. In many cases, the terms disease, disorder, morbidity and illness are used interchangeably dislocation Complete disruption in the normal relationship of two bones forming a joint (no contact of the articular surfaces). The direction of the dislocation is described by the position of the distal bone (eg, with an anterior dislocation of the shoulder, the humerus is displaced anteriorly to the scapula). The term subluxation applies when there is partial contact between the two surfaces.The term “dislocation” is sometimes misused to describe a displacement Illustration: Dislocated distal ulna 22

disorder In medicine, a disorder is a functional abnormality or disturbance. In many cases, the terms disease, disorder, morbidity and illness are used interchangeably displacement Out of place. A fracture is displaced if the fragments are not perfectly anatomically aligned. Displacement may be linear (or translational) — as when one fragment shifts sideways in relation to another — angular, rotational, or axial — when the displacement results in shortening along an axis. The term “dislocation” is sometimes misused to describe displacement. Dislocation is reserved for joint malalignment Illustration: In varus displaced humerus with 50% medially shifted distal fragment distal Away from the center of the body, more peripheral. For example, the hand is distal to the elbow, the phalanges are distal to the metacarpals See illustration directions distraction fracture is separation of the bone fragments in the longitudinal axis dorsal Pertaining to the back of the body in the anatomical position. An exception is the foot: the top of the foot, even though it faces forward in the anatomical position, is called the dorsum See illustration directions dorsal decubitus Lying on the back. More popular is the term supine dorsiflexion Movement of the top of the foot toward the anterior surface of the tibia dorsum The back or posterior side of a structure. "Dorsum" is the Latin word for the back. Something pertaining to or in direction to the dorsum is dorsal ductility The ductility of an implant material characterizes the degree of plastic deformation it tolerates before rupture dye‐punch fracture An intra‐articular fracture of the ulnar (medial) portion of the distal radius, usually caused by direct impaction of the lunate onto the lunate fossa of the distal radius 23

dynamization The process whereby mechanical load transferred across a fracture locus can be increased at a certain stage to enhance bone formation or to promote “maturation” of the healing tissues. An example would be the reduction in stiffness of an external fixation by either loosening some clamps, reducing the number of pins, or moving the tubular construct further from the bone. Intramedullary nails can be locked dynamically as well. Early dynamization, i.e., before solid bridging of the bone, can result in stimulation of callus formation. The value of late dynamization is debatable dysplasia A broad term that describes a condition affecting growth or development in which the primary defect is intrinsic to bone or cartilage dystrophy A condition resulting from defective or faulty nutrition, broadly construed to include nourishment of tissue by all essential substances, including those normally produced by the body itself

e ectomy Termination to indicate excision of the structure or organ designated by the root to which it is affixed, for example, tonsillectomy, hysterectomy, diskectomy ectopic Located away from normal position; out of place Illustration: Ectopic bone in the elbow edema Condition in which fluid escapes into the tissues from vascular or lymphatic spaces and causes local or generalized swelling elastic deformation Object returns to its original shape after deformation. See also plastic deformation elastic fixation See flexible fixation elevation Movement of the upper extremity on the plane of the scapula or to the front

embolism is the obstruction of a blood vessel by a foreign substance, fat or a blood clot blocking the vessel. An embolus travels through the bloodstream, lodges in a vessel and plugs it. See also fat embolism embolus An embolus (plural emboli) is any detached, itinerant intravascular mass (solid, liquid or gaseous) as carried by the circulation and capable of clogging arterial capillary beds (create an arterial occlusion) at a site distant from its point of origin emphysema Abnormal condition of the lungs marked by decreased respiratory function; associated with smoking or chronic bronchitis or old age endochondral ossification is one of the two essential processes during fetal development of the mammalian skeletal system by which bone tissue is created. Unlike intramembranous ossification, which is the other process by which bone tissue is created, cartilage is present during endochondral ossification. It is also an essential process during the rudimentary formation of long bones, the growth of the length of long bones, and the natural healing of bone fractures endoscope is an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ endoscopy is a broad term used to described examining the inside of the body using a lighted, flexible instrument called an endoscope See illustration arthroscopy endosteal The adjective derived from endosteum endosteum Highly vascular membrane lining the internal surface (medullary canal) of long bones, such as the femur and humerus. The endosteum plays an active part in the blood supply to bone, in fracture repair, and in bone remodeling See illustration long bone energy transfer When tissues are traumatized, the damage is due to energy that is transferred to the tissues. This is most commonly due to the transfer of kinetic energy from a moving object (car, missile, falling object, etc.). The greater the amount of energy transferred to the tissue, the more extensive the damage See illustration kinetic energy

epicondylitis Epicondylitis is an inflammation or damage to the area of an epicondyle of bone. An epicondyle is a projection of bone above a condyle (a rounded prominence at the end of a bone, usually where the bone connects to another bone) where ligaments and tendons are attached. Two common types of epicondylitis are tennis elbow and golfer's elbow. Tennis elbow is also known as lateral epicondylitis, which is an overuse injury to the area of the lateral (outside) epicondyle of the elbow end of humerus. Golfer's elbow (medial epicondylitis) is an overuse injury similar to tennis elbow, but in this case the damage occurs in the area of the medial epicondyle of the humerus epidemiology is the study of patterns of health and illness and associated factors at the population level. It is the cornerstone method of public health research, and helps inform evidence‐based medicine for identifying risk factors for disease and determining optimal treatment approaches to clinical practice and for preventative medicine epiphysis The end of a long bone which bears the articular component. The epiphysis develops from the cartilaginous element between the joint surface and the growth plate— Expression not to be used in adults! See metaphysis See illustration cartilage Evans classification system classification system for trochanteric fractures eversion Usually used in reference to the foot. Combination of dorsiflexion, pronation and abduction

evidence‐based medicine Evidence‐based medicine (EBM) or evidence‐based practice (EBP) aims to apply the best available evidence gained from the scientific method to clinical decision making. It seeks to assess the strength of evidence of the risks and benefits of treatments (including lack of treatment) and diagnostic tests. Evidence quality can range 26

from meta‐analyses and systematic reviews of double‐blind, placebo‐controlled clinical trials at the top end, down to conventional wisdom at the bottom. EBM/EBP recognizes that many aspects of health care depend on individual factors such as quality‐ and value‐of‐life judgments, which are only partially subject to scientific methods. EBP, however, seeks to clarify those parts of medical practice that are in principle subject to scientific methods and to apply these methods to ensure the best prediction of outcomes in medical treatment, even as debate continues about which outcomes are desirable evidence‐based practice See evidence‐based medicine excision Removal by cutting explant Removing a device that had been implanted extension The opposite of flexion; the process of straitening or the state of being strait See illustration flexion extension deformity In orthopedics extension deformity is a term for a deformity with posterior angulation of a bone or joint on the sagittal plane whereas the apex (peak) of the angle is backwards oriented. The deformity is also called recurvatum. A genu recurvatum is a deformity in the knee joint, so that the knee bends backwards See illustration recurvatum extensor A muscle which contraction extends or straightens a limb or body part. Antagonist: flexor external fixation External fixation is a method of immobilizing bones to allow a fracture to heal. External fixation is accomplished by placing pins or screws into the bone on both sides of the fracture. The pins are then secured together outside the skin with clamps and rods. The clamps and rods are known as the "external frame". An external fixator is a splint and provides relative stability external rotation Rotation of a bone about its long axis and away from the midline. Also called lateral rotation extra‐articular fracture Does not involve the articular surface, but may be intracapsular, e.g. femoral neck fractures extracapsular fracture occurs near, but outside the capsule of a joint, especially the hip 27

extrinsic From the Latin “extrinsecus” meaning from outside. 1. Not an essential or inherent part of a something such as a structure. 2. Coming from the outside. The opposite of extrinsic is intrinsic

f far cortex The cortex opposite to the surgeon and the insertion of an implant. It is usually a term used in relation to plating, interfragmentary screw fixation, and tension band wiring. Opposite: near cortex. The terms “1st and 2nd cortex shouldn’t be used fascia A sheet or band of fibrous connective tissue; lies deep under the skin and envelops muscle and muscle groups fascial compartment a part of the body that is walled off by fascial membranes, usually containing a muscle or group of muscles or an organ. See muscle compartment See illustration muscle compartment fasciectomy See fasciotomy fasciocutaneous A term describing tissue flaps which include the skin, the subcutaneous tissues, and the associated deep fascia as a single layer fasciotomy Fasciotomy or fasciectomy is a surgical procedure where the fascia is cut to relieve tension or pressure (and treat the resulting loss of circulation to an area of tissue or muscle). Fasciotomy is a limb‐saving procedure when used to treat acute compartment syndrome. See illustration muscle compartment fat cell See adipocyte fat embolism A process by which fat tissue passes into the bloodstream and lodges within a blood vessel. In general, an embolus is something that travels through the bloodstream, lodges in a blood vessel, and blocks it. A fat embolus is a fat particle or droplet that travels through the circulation and eventually blocks a blood vessel. Fat emboli tend to be small and multiple, causing numerous signs and symptoms. Up to 90% of cases are associated with trauma, and fracture or surgery on a large bone, such as the femur. As a result of the broken bone, the bone marrow fat escapes into the bloodstream See illustration embolism fat employ syndrome Fat Embolism Syndrome (FES) is distinct from the presence of fat emboli. Symptoms usually occur 1‐3 days after a traumatic injury and are predominantly: pulmonary (shortness of breath, hypoxemia), neurological (agitation, delirium, or coma), 28

dermatological (petechial rash), and haematological (anaemia, low platelets). The syndrome manifests more frequently in closed fractures of the pelvis or long bones. The petechial rash, which usually resolves in 5‐7 days is said to be pathognomonic of the syndrome; however, it occurs in only 20‐50% of cases. See also embolism and fat embolism See illustration embolism fatigue A condition leading to the eventual fatigue fracture of a material (such as bone) due to constant or repeated stresses fatique fracture See stress fracture femoral nerve palsy Pain and weakness in the femoral nerve distribution as the result of a stretch or trauma to the nerve. Patients complain of difficulty in walking and of knee buckling, depending on the severity of the injury FES. See fat emboli syndrome and embolism fibroblasts Fibroblasts is the most common type of cell found in connective tissue. Fibroblasts secrete collagen proteins that are used to maintain a structural framework for many tissues. They also play an important role in healing wounds fibrocartilage Tissue consisting of elements of cartilage and of fibrous tissue. This may be a normal anatomical entity, such as certain intra‐articular structures (menisci, triangular fibrocartilage of the wrist, the symphysis pubis) or constitute the repair tissue after lesion of the articular cartilage fibrochondrocytes Cells found in the meniscus, the fibro‐cartilaginous tissue within the knee joint. Fibrochondrocytes have features of chondrocytes and fibroblasts fibular stress fracture A fracture usually located a few centimeters above the ankle joint as the result of repetitive loads on the bone that cause an imbalance of bone resorption over formation fixation, flexible See flexible fixation fixation goal Depends on the fracture site. It can be either rigid (direct reduction / absolute stability) or stable (indirect reduction / relative stability) flat bone Any bone that is not rounded in cross section. The sternum, pelvis, skull are examples of flat bones flatfoot A foot in which the arch of the instep is flattened and the entire sole touches the ground flexible fixation Traditionally, internal fixation according to the AO method has meant absolutely stable (rigid) fixation, using close adaptation and compression. Recently, a less stable fixation (flexible fixation using splinting plates, nails, or external fixators) has been observed to yield very good results under conditions in which the fragments are well 29

vascularised. Given best preservation of the viability of the fragments, flexible fixation induces abundant and rapid callus formation. Recall that the combination of instability and compromise of the biology of the fracture locus is deleterious. See also biological fixation flexibility (anatomy) refers to the absolute range of movement in a joint or series of joints, and length in muscles that cross the joints flexion Bending. The movement of an articulation that causes the relationship between the part above the joint and the part below the joint to become more angulated flexion deformity In orthopedics flexion deformity is a term for a deformity with anterior angulation of a bone or joint on the sagittal plane, whereas the apex (peak) of the angle is forwards oriented. The deformity is also called procurvatum flexor A muscle that when contracted acts to bend a joint or limb in the body. Antagonist: extensor floating knee Isolation of the knee joint from the remainder of the skeleton by fractures of the (distal) femur and the (proximal) tibia in the same limb fluoroscopy See c‐arm foramen A small opening or perforation through bone or a membranous structure foraminotomy The removal of overlying bone to enlarge a foramen force An action that changes the state or motion of a body to which it is applied. Can be external, such as gravity, or internal, such as forces generated by muscles, bone, and soft‐ tissue deformation. The unit for measure for force in the metric system is the Newton fracture A loss of continuity (breakage), usually sudden, of any structure resulting when internal stresses produced by load exceed the limits of its strength. The complexity and displacement of the fracture depend largely on the energy build‐up in the structure prior to fracture; the shape of the fracture planes (transverse fracture, oblique fracture, spiral fracture, avulsion, impaction, etc.) is related to the nature of the load: compressive, bending, torsional, shear, or any combination of these 30

fracture, articular See intra‐articular fracture and partial articular fracture

fracture callus See callus fracture disease is a chronic neurological syndrome characterized by: severe burning pain; pathological changes in bone and skin; excessive sweating; tissue swelling; extreme sensitivity to touch. Other names given to fracture disease are: algodystrophy: Complex Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy (RSD) fracture, extra‐articular See extra‐articular fracture fracture locus (injury zone): Locus derives from the Latin word for “place”. It is used to describe the biological unit comprising the fracture fragments and the immediately associated soft tissues, all of which function together to produce healing of the injury fracture impacted See impacted fracture fracture mulitfragmentary See multifragmentary fracture fracture reduction Reduction is the positioning a bone or bones to their normal position after a fracture or dislocation. The goal of the reduction is to restore function by restoring anatomical relations (alignment, rotation, and length) of the bone or joint, to decrease pain, to prevent later deformity, and to encourage healing fracture simple See simple fracture fragility fracture Spontaneous fracture without fall or fracture produced by a fall from standing height or less, mainly due to osteoporosis friction corrosion is the erosion of material from a solid surface by the action of another surface. It is related to surface interactions and more specifically the removal of material from a surface as a result of mechanical action frontal Pertaining to the front of the body in the anatomical position. The frontal plane of the body, parallel to the front, is the same as the coronal plane See illustration body planes frozen shoulder A condition characterized by restricted shoulder movement resulting from acute trauma or a periarticular biceps or rotator cuff injury fulcrum In (bio)mechanics, the support about which a lever pivots functional reduction Restoring anatomical relations and fixation with relative stability: axis, length, rotation Cave: restoring the anatomy or anatomical relations is not the same as anatomical reduction fusion The surgical immobilization of a joint; see arthrodesis

g Galeazzi injury A fracture of the radial shaft associated with a dislocation of the distal radioulnar joint. Its first description is attributed to Galeazzi (1934). Sometimes referred to as the “reversed Monteggia” galvanic corrosion is an electrochemical process that occurs when two different metals are in contact with each other and immersed in an a liquid with electrolytes gap healing the healing process taking place between two fragment ends kept in stable relative position with a small gap between them. Gap healing progresses in two phases: 1) the filling of the gap with lamellar bone orientated parallel to the plane of the fracture gap, 2) the subsequent osteonal remodelling of the newly formed lamellar bone genesis A suffix referring to the beginning, development, or production of something. For example, osteogenesis is the production of bone germ A cell or group of (pathogenic) cells capable of developing into an organ, a part or an organism in its entirety glenohumeral instability Glenohumeral instability is the inability to maintain the humeral head centered in the glenoid fossa. Clinical cases of instability can be characterized according to the circumstances under which they occur, the degree of instability, and the direction of instability glide hole When a fully threaded screw is used as a lag screw, the cortex under the screw head (near cortex) should not engage the screw threads. This can be accomplished by over‐drilling the near cortex screw hole to at least the size of the outer diameter of the screw thread gliding hole Incorrect term: The hole is not gliding anywhere. See glide hole gliding splint A splint (such as an unlocked intramedullary nail, PFNA or a DHS) which allows for axial shortening. Such a splint provides the possibility for the re‐establishment of bony coaptation under conditions of fragment end shortening due to bone surface resorption 32

goal of fracture treatment The goal of fracture treatment is to restore optimal function of the limb in respect to mobility and loadbearing capacity. The goal is, furthermore, to prevent early complications, such as reflex sympathetic dystrophy, fracture disease, (Sudeck’s atrophy) and, in the case of polytrauma, multiple system organ failure, as well as late sequelae, such as posttraumatic arthrosis golfer's elbow (medial epicondylitis) is an overuse injury similar to tennis elbow, but in this case the damage occurs in the area of the medial (inside) epicondyle of the humerus gonarthrosis Degenerative arthrosis (osteoarthritis) of the knee joint graft Any free (unattached) tissue or organ for transplantation; to transplant such structures. See autograft; allograft; xenograft greenstick fracture A fracture that disrupts only one side of the bone. This fracture pattern is seen in children because of the greater plasticity of their bones growth factors are a naturally occurring substances capable of stimulating cellular growth, proliferation and cellular differentiation. Usually it is a protein (e.g. bone morphogenic protein (BMG)) are important for regulating a variety of cellular processes Gustilo(‐Anderson) Classification system for open soft tissue lesions. This scale comprises grades 1, 2, 3A, 3B & 3C, from the least to the most severe soft tissue damage

h hallux The great toe hallux rigidus A painful loss of motion of the great toe metatarsophalangeal joint caused primarily by arthrosis (osteoarthritis) hallux valgus A big toe (hallux) that is bent outward (valgus) so it overlaps the 2nd toe. A bunion is a localized painful swelling at the base of the big toe that can accompany hallux valgus. It is frequently associated with inflammation hallux varus An inward bending (varus) of the joint of the big toe (hallux) hammer toe Deformity at the first metatarsophalangeal joint where the proximal phalanx deviates laterally; also known as a bunion. May require surgical correction See illustration bunion Haversian canal Tubes around narrow channels formed by lamellae. See Haversian system Haversian remodeling Direct bone healing without formation of callus Haversian system The cortical bone is composed of a system of small channels (osteons) about 0.1 mm in diameter. These channels contain the blood vessels and are remodeled after a disturbance of the blood supply to bone. There is a natural turnover of the Haversian systems by continuous osteonal remodeling; this process is part of the dynamic and metabolic nature of bone. It is also involved in the adaptation of bone to an altered mechanical environment. See Wolff’s law Hawkin's test A test for subacromial impingement at the shoulder. With the arm in the throwing position and flexed forward about 30 degrees, passively internally rotate the humerus. Pain suggests impingement of the supraspinatus tendon against the coraco‐ acromial ligament

healing Restoration of the original integrity. The healing process after a bone fracture lasts many years, until internal fracture remodeling subsides. For practical purposes, however, healing is considered to be complete when the bone has regained its normal stiffness and strength hematogenous Blood‐borne hematoma An abnormal localized collection of blood in which the blood is usually clotted or partially clotted and is usually situated within an organ or a soft tissue space, such as within a muscle. A hematoma is caused by a break in the wall of a blood vessel. The break may be spontaneous, as in the case of an aneurysm, or caused by fatigue or a trauma hemarthrosis A collection of blood within a joint haematopoiesis (or hematopoiesis in the United States; sometimes also haemopoiesis or hemopoiesis) is the formation of blood cellular components. All cellular blood components are derived from haematopoietic stem cells hematopoietic stem cell A stem cell from which all red and white blood cells develop hemiarthroplasty is a surgical procedure which replaces one half of the joint with an artificial surface and leaves the other part in its natural (pre‐operative) state. This class of procedure is most commonly performed on the hip after a subcapital (just below the head) fracture the neck of the femur (a hip fracture) hernia A general term referring to a protrusion of a tissue through the wall of the cavity in which it is normally contained heterograft See allograft and xenograft hip fracture Broken bone in the hip, a key health problem among the elderly, usually due to a fall or other kind of trauma involving direct impact to the hip bone which has been weakened by osteoporosis. The part of the hip most often broken is the greater trochanter of the femur Hoffa fracture Fracture of the femoral medial condyle in the coronal plane. Sometimes also the bilateral condylar fractures in the coronal plane are called Hoffa fracture homeostasis The ability or tendency of an organism or cell to maintain internal equilibrium by adjusting its physiological processes homograft See allograft and autograft See illustration autograft 35

homolateral pertaining to the same side of the body. Also called ipsilateral horizontal Parallel with the horizon (see also transverse) See illustration body planes Howship’s lacuna is a small cavity within the bone matrix, containing an osteocyte hyaline cartilage Hyaline cartilage is a low‐friction cellular, avascular tissue that coats joint surfaces. See also cartilage hydroxyapatite (HA) A calcium phosphate salt. Hydroxyapatite is the main mineral component of bone matrix that is deposited into the organic framework to make the bone hard and strong hyperextension ‐ The extension of a limb or joint beyond its normal limit hypothermia Temperature below nominal value hyperthermia Temperature above nominal value hypertrophic nonunion If a fracture fails to heal, despite good fracture locus biology, due to a mechanical environment which is so unstable as to frustrate the tissue responses, the non‐union is categorised as hypertrophic. Abundant new bone formation will often produce the so‐called “elephant’s foot” appearance on x‐ray hypertrophy Enlargement or overgrowth of an organ or part of the body due to increased size of the constituent cells hypovolemia A state where the circulating blood volume is reduced. This can occur due to haemorrhage, or other loss of fluid, such as dehydration. It can lead to shock. See also anaphylaxis hypoxia: A state where the oxygen level in the arterial blood, or in other tissue, is pathologically reduced

i iatrogenic The terms iatrogenesis and iatrogenic artifact refer to inadvertent adverse effects or complications caused by or resulting from medical treatment or advice idiopathic disease is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause

illness. Illness and sickness are generally used as synonyms for disease. In many cases, the terms disease, disorder, morbidity and illness are used interchangeably impacted fracture A stable, and usually simple, fracture of the metaphysis in which the fragments are driven one into the other, resulting often in shortening and inherent fracture stability Illustration: CT‐scan of an impaction fracture of the tibia plateau image intensifier See c‐arm impingement An encroachment on the space occupied by soft tissue, such as nerve or muscle impingement syndrome Impingement syndrome occurs when tendons and/or muscles of the rotator cuff (primarily supraspinatus muscle) and the subacromial bursa are compressed between the bones of the shoulder. Impingement syndrome may result in pain, weakness and loss of movement at the shoulder and is only diagnosed when symptoms persist and interfere with normal daily activity. Chronic impingement may lead to bursitis, rotator cuff tendonitis, and, if left untreated, thinning or rupture of the rotator cuff tendons implant A device, tissue or substance that is transferred, grafted or inserted into the living body in situ In its original or normal place or natural position in vitro Taking place outside a living organism in a test tube or Petri dish in vivo Taking place in the living body of a human, animal or a plant. incision a cut made with a scalpel during a surgical operation indirect bone healing Bone healing as observed in fractures treated either with relative stability, or left untreated. Callus formation is predominant; the fracture fragment ends are resorbed by osteoclasts. Bone formation results from a process of transformation of fibrous and/or cartilaginous tissue into bone by osteoblast activity See illustration callus indirect ossification See indirect bone healing

indirect reduction implies that the fracture lines are not directly exposed and seen, and that the fracture area remains covered by the surrounding soft tissues. Reduction is accomplished by ligamentotaxis or using instruments or implants introduced away from the fracture zone, or through minimal incisions. Some specific implants, like the intramedullary nail or a bridge plate act simultaneously as a reduction tool and as a stabilization system. Valid mostly in diaphyseal and metaphyseal fractures Illustration: Indirect reduction with a bridge plate infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease. Colloquially, infections are usually considered to be caused by microorganisms or microparasites like viruses, prions, bacteria, and viroids, though larger organisms like macroparasites and fungi can also infect. infective non‐union Failure of a fracture to heal due to an infection inferior Literally below or lesser than. In the anatomical position, if A is lower than B, A is inferior to B. The opposite is superior See illustration directions inflammation A localized tissue response initiated by the injury or destruction of vascularised tissues. Inflammation heat, redness, swelling, and pain that accompany musculoskeletal injuries; occurs when tissue is crushed, stretched, or torn injury severity score (ISS) is an established medical score to assess trauma severity. It correlates with mortality, morbidity and hospitalization time after trauma. It is used to define the term major trauma Each injury is assigned an Abbreviated Injury Scale (AIS) score and is allocated to one of six body regions (Head, Face, Chest, Abdomen, Extremities (including Pelvis), External). Only the highest AIS score in each body region is used. The 3 most severely injured body regions have their score squared and added together to produce the ISS score instability Looseness or an inability to withstand normal physiologic loading without motions on the fracture surfaces

interfragmentary compression: Static compression applied to a fracture plane imparts a high degree of stability to the fragments and thus reduces micromotion and strain. Bone surface resorption does not then occur. There is no demonstrable proof that interfragmentary compression, per se, has any effect upon internal remodeling of the cortical bone internal fixator See locking internal fixator internal fixation Surgical insertion of a device that stops motion across a fracture or joint to encourage bony healing or fusion. See also ORIF internal rotation Rotation of a bone about its long axis and towards the midline. Also called medial rotation See illustration external rotation intraarticular fracture. Fracture of the articular surface whereby the entire articular block is separated from the diaphysis. Requires anatomical reduction and fixation with absolute stability. See also partial articular fracture intracapsular fracture occurs within the capsule of a joint interosseous membranes connect bone to bone as for example the fibula with the tibia intramedullary nail—locked or unlocked: An intramedullary nail provides some degree of stability, mainly as a result of its stiffness. An unlocked nail will allow the fragments to slide together along the nail; the fracture must, therefore, be provided with a solid support against shortening ‐ see gliding splint. For the treatment of multifragmentary fractures, where there is axial instability (the fear of collapse into a shortened position), the nail can be interlocked above and below the fracture locus to prevent this shortening and also to reduce rotational displacement. This is achieved by locking bolts traversing a locking hole prepared in the nail and passing through the cortex on either side of the nail. If the locking hole is round and matches the size of the locking bolt, then static locking has been achieved. If the locking hole is elongated in the nail’s long axis, the possibility of a limited excursion of axial movement is achieved, whilst preserving the rotational control ‐ so‐called dynamic locking intramembranous ossification mainly occurs during formation of the flat bones of the skull but also the mandible, maxilla, and clavicles; the bone is formed from connective tissue such as mesenchymal connective tissue rather than from cartilage intraoperative During surgery. Literally, within surgery intrinsic 1) An essential or inherent part of a something such as a structure. 2) Coming from within, from the inside. Proteins for example have intrinsic signals that govern their transport and localization in the cell. The opposite of intrinsic is extrinsic intro Into; beginning inversion Usually used in reference to the foot. Combination of plantar flexion, supination and adduction See illustration eversion

inversion injury Ankle injury resulting from landing on the lateral aspect of the foot ipsilateral pertaining to the same side of the body. Also called homolateral irregular bone Any bone with a complex shape that is neither round or flat. The vertebrae are irregular bones irrigation Mechanical cleansing of a cavity or wound with a stream of fluid ischemia Absence of blood flow ISS See injury severity score istmus Also spelled isthmus. A constriction or narrow passage connecting two larger parts of an organ or other anatomical structure

j Jakob‐Creutzfeldt disease See: Creutzfeldt‐Jakob disease (CJD) joint A joint is a connection between 2 or more bones joint capsule saclike envelope of connective tissue, enclosing the cavity of a synovial joint, that contributes to joint stability and contains synovial liquid for the lubrication of the joint joint mobilization Passive movement techniques used to treat joint dysfunctions such as stiffness, reversible joint hypomobility and pain juxtaarticular The prefix "juxta‐" comes from the Latin preposition meaning near, nearby, close. Juxtaarticular is composed of juxta, near + articular, from the Latin "articulus", a joint = near a joint. A juxtaarticular fracture is a break near a joint; juxtaarticular infection is infection near a joint; and so on. Synonym: periarticular

k kilonewton kN. 1 kN (1000 Newton) equals 101.97162 kilograms of load. Kilonewtons are often used for stating safety holding values of fasteners, anchors and more in the building industry. They are also often used in the specifications for rock climbing equipment kinematics The study of the movement of rigid structures without reference to the cause of motion, ie, independent of the forces that produce it kinesiology The study of motion of the human body

kinetic energy The kinetic energy of an object is the energy which it possesses due to its motion. It is defined as the work needed to accelerate a body of a given mass from rest to its stated velocity. Having gained this energy during its acceleration, the body maintains this kinetic energy unless its speed changes. The same amount of work is done by the body in decelerating from its current speed to a state of rest. Kinetic energy cannot be destroyed. When a moving object is slowed or stopped, its kinetic energy is converted into other energy. If a moving object strikes a slower or stationary object, it imparts some of its kinetic energy to the body that it strikes. This may accelerate the other body (or parts of it), causing damage, or produce other energy transfer effects. See Energy transfer Kirschner wire K‐wire. A threaded or trocar pointed metallic wire with a small diameter

l lag screw Produces interfragmentary compression by driving the near fragment with a glide hole beneath a screw head against the far fragment in which the screw threads obtain purchase The compression produced by a screw so inserted acts directly within the fracture surface and is, therefore the most efficient method in order to achieve interfragmentary compression. A lag screw can be positioned independently or through a plate hole in an approximately perpendicular angle to the fracture line lacunae Tiny cavities within the matrix of the bone that contain osteocytes lamellae Concentric layers of bone lamellar bone Mature layered bone in which the tubular lamellae are formed, which are characterized by parallel spirally arranged collagen fibers 41

lateral In anatomy, the side of the body or a body part that is farther from the middle or center of the body. Typically, lateral refers to the outer side of the body part, but it is also used to refer to the side of a body part. For example, when referring to the knee, lateral refers to the side of the knee farthest from the opposite knee. The opposite of lateral is medial See illustration directions lesion A lesion can be almost any abnormality involving any tissue or organ due to any disease or any injury. Because the definition of a lesion is so broad, the varieties of lesions are virtually endless lever arm The distance between two opposite forces which causes the creation of a moment, turning force. If the forces are equal and opposite, the presence of a lever arm maintains lateral equilibrium but break rotational equilibrium, this is called a couple ligament A ligament is a tough band of connective tissue that connects bones. A ligament imparts stability, preventing excessive motion in certain directions ligamentotaxis Traction in the long axis of the limb; only possible when the fragments are still connected to some soft tissues (not necessarily ligaments) Lisfranc fracture The Lisfranc fracture is a fracture of the foot in which one (usually the 2nd) or all of the metatarsals are displaced from the tarsus load Overall force exerted on a body or structure load bearing When the bone is not able to take load e.g. in comminuted fractures, the whole load is on the implant. Term used to describe a device (implant) which is sufficiently strong to function as a bridge across a weakened segment of bone and to maintain length, axial alignment, rotation and stability 42

load shearing The bone is able to take load. The bone is part of the fracture fixation thus the load is shared between the bone and the implant locking head screw Screws with external threads cut onto the head, which provide a mechanical couple to an internal thread in the screw hole of a plate, thus creating a fixed angle device locking internal fixator (LIF) Fixed angle device. Implant consisting of a plate (e.g. LCP) and locking screws, offering angular and axial stability, bridging the fracture and providing fixation with relative stability. Stability of the fixation doesn’t depend on plate‐bone contact long bone Any cylindrical bone that is longer than it is wide. Examples are the femur, humerus, and tibia longitudinal Lengthwise and parallel with long axis of body or part. luxation See dislocation lymphedema Accumulation of oedema fluid in the tissues as a result of poor drainage of the lymph, usually due to the incompetence, or obstruction, of the lymphatic vessels. lysis Destruction. Osteolysis is the destruction bone cells etc.

m magnetic resonance imaging See MRI 43

Maisonneuve fracture The Maisonneuve fracture is a (mostly spiral) fracture of the proximal third of the fibula associated with a tear of the distal tibiofibular syndesmosis and the interosseous membrane. There is an associated fracture of the medial malleolus or rupture of the deep deltoid ligament Illustration: Maisonneuve fracture: fracture of the posterior malleolus (Volkmann’s triangle) and proximal fibula malacia Softening. For example, osteomalacia is the softening of the bones due to defective bone mineralization secondary to inadequate amounts of available phosphorus and calcium while chondromalacia is softening of cartilage malignant 1. Tending to be severe and become progressively worse. 2. In regard to a tumor, having the properties of a malignancy that can invade and destroy nearby tissue and that may spread (metastasize) to other parts of the body malunion Consolidation of a fracture in a position of deformity See illustration deformity mangled extremity severity score See MESS marrow See bone marrow matrix Intercellular substance of bone, consisting of collagenous fibers, ground substance, and inorganic salts. Works as a scaffold for the growth process. Enables fast bone growth from the outside into the defect mechanism of injury The mechanism of injury refers to the way damage to skin, muscles, organs and bones happens medial Pertaining to the middle; in or toward the middle; nearer the middle of the body. Medial is the opposite of lateral. For example, the medial side of the knee is the side closest to the other knee whereas the lateral side of the knee is the outside of the knee See illustration direction medial rotation Rotation of a bone about its long axis and towards the midline. Also called internal rotation median Middle median body plane Sagittal body plane, dividing the body into a right and a left half See illustration body planes

medullary canal The central canal in a long bone that contains bone marrow megapascal (MPa) is a measure of force per unit area, defined as 1’000 newton per square meter. See Newton membrane A very thin layer of tissue that covers a surface or that connects anatomical structures. See interosseous membrane meniscus A soft‐tissue structure that lines some joints and provides load distribution, shock absorption. mesenchymal connective tissue or mesenchyme, is a type of loose connective tissue mesenchymal stem cell Stem cells that can differentiate into osteoblasts, chondrocytes, muscle cells MESS Mangled Extremity Severity Score Traumatology A scoring system used to evaluate the need for amputation in an extremity; a MESS of ≥ 7 indicates a need to amputate Altering factors Loss of posterior tibial nerve causes trophic ulceration, ischemia > 6 hrs doubles score. metaphysis The segment of a long bone located between the joint and the shaft (diaphysis). It consists mostly of cancellous bone within a thin cortical shell 45

metastasis The process by which cancer spreads from the place at which it first arose as a primary tumor to distant locations in the body methylmethacrylate is an organic, colourless, liquid compound. Methylmethacrylate is a monomer produced on a large scale for the production of the polymer polymethylmethacrylate (PMMA), a hard plastic, commonly used as bone cement microorganism are very tiny one‐celled organisms , such as bacteria and fungi. They are found everywhere in the world ‐ in all living things: plants, humans and animals. Microorganisms can live in the air, on land, and in fresh or salt water environments. Some of them, pathogens, can be harmful and causing diseases, but there are some microorganisms that are needed for living organisms to survive. Viruses and prions are not microorganisms but infectious particles microvascular Pertaining to microscopic blood vessels. Microvascular tissue transfer is related to the technical need for an operating microscope to perform the anastomoses (see anastomosis) midline The center line of the body in the anatomical position minimal invasive plate osteosynthesis (MIPO) reduction and plate fixation without direct surgical exposure of the fracture site, using small skin incisions and sub‐muscular insertion of the plate. minimal invasive surgery (MIS) means damage limitation; “closed” reduction, mainly by indirect manoeuvres; biology of the bone is not determined by the length of the skin incision but by indirect reduction technique and gentle soft tissue handling. From mechanical to biological priorities (primary vs. secondary bone healing) Illustration: Incisions for minimal invasive plating MIPO See minimal invasive plate osteosynthesis MIS See minimal invasive surgery modelling The process by which bone is altered in size and shape during its growth by resorption and formation of bone at different sites and rates modulus of elasticity A measure of the stiffness of a metal. The modulus of elasticity is the mathematical description of an object or substance's tendency to be deformed elastically (i.e., non‐permanently) when a force is applied to it monocyte A white blood cell that has a single nucleus and can ingest (take in) foreign material. In other words, a monocyte is thus a mononuclear phagocyte that circulates in the blood

Monteggia injury A displaced ulnar fracture associated with a dislocation of the radial head from its articulation with the capitellum. First described in the 19th century by Giovanni Batista Monteggia, an Italian physician morbidity Morbidity (from Latin morbidus: sick, unhealthy) refers to a diseased state, disability, or poor health due to any cause. The term may be used to refer to the existence of any form of disease, or to the degree that the health condition affects the patient. In many cases, the terms disease, disorder, morbidity and illness are used interchangeably mortise The mortise is a cavity cut into a timber (or any other structure) to receive a tenon. There are several kinds of mortises, e.g. an open mortise, a mortise that has only three sides, like the ankle joint for example mortise view View of the ankle rotated ~ 20° internally until medial and lateral malleoli are parallel to film Illustration: mortise view of ankle joint MRI Magnetic resonance imaging = magnetism is applied to the human body, and the response of atoms in a tissue will produce a computerized image. Images look similar to a CT scan but with much higher details in the soft tissues. MRI does not a very good job in bones (less fluid = less hydrogen atoms) multifragmentary fracture A term used to characterize any fracture with one or more completely separated intermediate fragment(s). In the diaphyseal and metaphyseal segments, it includes the wedge and the complex fractures. The terms wedge and complex are used only for diaphyseal or metaphyseal fractures muscle Muscle is the tissue of the body made up of bundles of cells or fibers that move body parts by lengthening and shortening. There are three types of muscle in the body. Muscle which is responsible for moving extremities and external areas of the body is called "skeletal muscle." Heart muscle is called "cardiac muscle." Muscle that is in the walls of arteries and bowel is called "smooth muscle" muscle cell An elongated contractile cell that forms the muscles of the body; myocyte muscle compartment An anatomical space, bounded on all sides either by bone or deep fascial envelope, which contains one or more muscle bellies. The relative inelasticity of its walls means that if the muscle tissue swells, the pressure in the osseo‐fascial envelope can increase to levels which cut off the flow of blood to the muscle tissue, resulting in its severe compromise or death—so‐called muscle compartment syndrome Illustration: Muscle compartments of the lower leg 47

myositis ossificans The formation of lamellar bone within muscle, often as a result of blunt trauma

n near cortex The cortex near the operator and on the side of insertion of an implant. It is usually a term used in relation to plating, interfragmentary screw fixation, and tension band wiring. Opposite: far cortex See illustration far cortex necrosis The death of living cells or tissues. Necrosis can be due, for example, to ischemia (lack of blood flow) necrotic non‐union Failure of a fracture to heal due to a bone necrosis Illustration: necrotic non‐union of scaphoid Greater Neer classification A system of classifying fractures of tuberosity the proximal end of the humerus, which is based on the Head presence or absence of significant displacement of one Tendon of or more of the four major bone segments (humeral long head head, lesser tuberosity, greater tuberosity, humeral biceps Lesser shaft). Fractures are described as one‐part (non‐ tuberosity Shaft displaced fracture of the surgical neck), two‐part, three‐ part or four‐part fractures nerve cell A unique type of cell found in the brain and body that is specialized to process (motor system) and transmit (sensory system) neutralization While the term “neutralization” has often been used in plate and screw fixation, the term “protection” should replace it. In reality true neutralization cannot be achieved. In plate fixation the plate reduces the load placed upon the interfragmentary fixation with a lag screw. It therefore protects the screw fixation from overload. See protection and see also stress shielding See illustration protection Newton The force required to accelerate a 1 kg mass at 1 m/s2. See also kilonewton Newtonmeter (Nm) The torque from a force of 1 Newton applied over a distance arm of 1 meter 48

non‐union. Failure of a fracture to heal; sometimes non‐unions are called pseudoarthrosis (false joint) but pseudoarthroses are only one form of non‐unions. Other forms of non‐ unions are necrotic, hypertrophic or infective non‐unions nucleus The nucleus is a highly specialized organelle that serves as the information processing and administrative center of the cell. Not all cells have a nucleus

o oblique fractures Not perpendicular or parallel to the body axis, e.g. at an angle of 45° omarthrosis Degenerative arthrosis (osteoarthritis) of the shoulder open fracture Fractures with an overlying, communicating wound of the skin, exposing the fracture site to contamination and the risk of infection. Open fractures are commonly graded according to the severity scale of Gustilo. open reduction Surgical fracture treatment. The opposite is closed reduction (conservative fracture treatment) operation Although there are many meanings to the word "operation", in medicine it refers to a surgical procedure opposition The action of opposing one part to another; if the pulp of the thumb is placed in contact with the pulp of a finger, the movement, or action, of the thumb is that of opposition ORIF A widely used abbreviation for Open Reduction and Internal Fixation (osteosynthesis) orthopaedics is the study of the musculoskeletal system. Orthopedic doctors specialize in diagnosis and treatment of problems of the musculoskeletal system. The musculoskeletal system includes: bones, joints, ligaments, tendons, muscles, and nerves orthopaedic surgery (or orthopaedics) The medical specialty devoted to the diagnosis, treatment, rehabilitation, and prevention of diseases of the body's musculoskeletal system ossification See osteogenesis . osteitis Inflammation of bone with enlargement tenderness , dull aching; many varieties

osteoarthritis also known as degenerative joint disease. Osteoarthritis is a condition which affects synovial joints and is characterized by loss of articular cartilage, reactive subchondral bone sclerosis (sometimes with subchondral cysts), and the formation of peripheral bony outgrowths ‐ osteophytes. The primary lesion is degeneration of the articular cartilage as a consequence of infection, trauma, overuse, congenital skeletal anomaly, or as part of the aging process. Actually the correct term for “osteoarthritis” is “arthrosis” Illustration: coxarthrosis osteoarthropathy Any disease of the bones and joints. From osteo‐, bone + ‐arthro‐, joint, + pathy osteoblast A specialized bone cell that produces and deposits the matrix that is needed for the development of new bone and consists primarily of collagen fibers. Osteoblasts are formed from mesenchymal stem cells on the outer surfaces of bone and in bone cavities, and bone deposition takes place constantly in living bone. As new bone grows and hardens with the addition of calcium and phosphate, osteoblasts become embedded in the bone matrix and develop into osteocytes. See also osteoclasts and homeostasis See illustration creeping substitution osteochondral Referring to bone and cartilage osteochondritis Inflammation of subchondral bone osteochondritis dissecans A condition in which a fragment of bone in a joint is deprived of blood and separates from the rest of the bone. Abbreviated OCD or OD osteoclast A specialized bone cell that absorbs bone, allowing for the deposition of new bone and maintenance of bone strength. Osteoclasts secrete enzymes that dissolve the matrix of old bone tissue and acids that dissolve bone salts, which contain calcium and phosphorus. Except in growing bone, the rate of bone deposition and bone absorption equal each other so that bone mass remains constant. See also osteoblast, osteocytes and homeostasis See illustration creeping substitution osteoconductive The ability of a substance or material to provide the framework (scaffold) for new bone osteocyte An osteocyte, a star‐shaped cell, is the most abundant cell found in compact bone. Cells contain a nucleus and a thin ring of cytoplasm. When osteoblasts become trapped in the matrix they secrete, they convert into osteocytes. The interaction of osteocytes and osteoblasts, in response to parathyroid hormone, in moving calcium from the bone fluid to the extracellular fluid compartment. See also osteoclasts 50

osteodystrophy A bone disorder that adversely affects bone growth osteogenic The capability of a material (e.g. cartilage) to differentiate into bone, graft containing live bone cells osteogenesis (or ossification) is the process of laying down new bone material by cells called osteoblasts. It is synonymous with bone tissue formation. There are two processes resulting in the formation of normal, healthy bone tissue: Intramembranous ossification is the direct laying down of bone into the primitive connective tissue (mesenchyme), while endochondral ossification involves cartilage as a precursor osteoid The organic matrix formed by osteoblasts that becomes bone when mineralized See illustration osteocyte osteoinduction Acceleration of new bone formation by chemical means osteoinductive A characteristic of a material to accelerate bone growth osteology The study of bones. The branch of anatomy or physical anthropology that deals with bones osteolysis Dissolution of bone. See osteolytic osteolytic Pertaining to the dissolution of bone, especially the loss of calcium from bone. "Punched‐out" osteolytic lesions are characteristic of metastatic lung and breast cancer and multiple myeloma osteomalacia is softening while chondromalacia is softening of cartilage osteomyelitis An acute or chronic inflammatory condition affecting periosteum, bone and its medullary cavity; usually the result of bone infection. This may be a blood‐borne infection (hematogenous osteomyelitis) ‐ usually in children or in the immunocompromised, or follow an open fracture (posttraumatic osteomyelitis) osteon The basic unit of compact bone, consisting of tightly packed concentric rings of tissue with a blood vessel running through the central canal; Haversian system osteopathy Any disease process of bone osteopenia An abnormal reduction in bone mass with intact micro architecture (trabeculae). – standard deviation <‐2.5. This may be generalized, as in some bone diseases, or localized, as a response to inflammation, infection, disuse, etc. see osteoporosis

osteophytes Bony outgrowth, usually found around joint area of bone; bone spur osteoporosis A reduction in bone mass with deteriorated micro architecture (trabeculae) – standard deviation > ‐ 2.5. It is a natural aging process but may be pathological. It can result in pathological fracture normal osteoporosis (most fractures of the femora l neck in the elderly are due to osteoporosis plus minimal trauma) ‐ see osteopenia and pathological fracture osteoprogenitor cell Cells in an intermediate stage of development between mesenchymal stem cell and osteoblast osteosynthesis A term coined by Albin Lambotte. “Synthesis” is derived from the Greek for making together, or fusing. Osteosynthesis means surgical fracture treatment and fixation of the bone fragments with implants osteotomy An osteotomy is a surgical procedure whereby a bone is cut to shorten, lengthen, or change its alignment. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture overbending (of plate): See prebending

p palmar Pertaining to the palm of the hand. Anterior direction referring to the hand See illustration direction palmar flexion Movement of the wrist with palm up in flexion 52

palpate To touch or feel palsy, Paralysis generally partial, whereby a local body area is incapable of voluntary movement (motor function). For example, radial nerve palsy that results in a “dropping hand” See also paralysis paraesthesia See paresthesia paralysis is loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling (sensory loss) in the affected area if there is sensory damage as well as motor paraplegia Paralysis of the lower part of the body including the legs. The loss of motor, sensory and reflex action of the lower half of the body is due to disease of or injury to the spinal cord. The suffix plegia means paralysis parathormone A hormone that is made by the parathyroid gland and that is critical to calcium and phosphorus balance. Deficiency of parathormone results in abnormally low calcium levels in the blood (hypocalcaemia). Excessive parathormone leads to elevated calcium levels in the blood (hypocalcaemia) and calcium deposition in cartilage. Also known as parathyroid hormone and parathyrin parathyroid hormone See parathormone paresis Partial or incomplete paralysis paresthesia An abnormal sensation of the skin, such as numbness, tingling, pricking, burning, or creeping on the skin that has no objective cause. Paresthesia is the usual American spelling and the preferred English spelling. Sensation of tingling and numbness associated with injury or irritation of a sensory nerve or nerve root partial articular fracture Only part of the joint is involved while the other part remains attached to the diaphysis. Require anatomical reduction and fixation with absolute stability pathogen A pathogen, is an infectious agent, or more commonly germ, is a biological agent such as a virus, bacteria, prion, or fungus that causes disease to its host pathologic fracture: A fracture through bone which is abnormal as a result of a pathological process. Generally the term is used for fractures due to bone tumor percutaneous In surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via stab incision of the skin, rather than by using an "open" approach where inner organs or tissue are exposed periarticular Around a joint. See also juxtaarticular periosteal Adjective derived from periosteum

periosteum Thick, fibrous, inelastic membrane containing vessels and nerves, covering the entire surface of the bone except articulating surfaces. The periosteum plays an active part in the blood supply to cortical bone, in fracture repair, and in bone remodeling pilon The distal end of the tibia – from the French for a stump, or a pestle pilon fracture the term pilon (French for pestle) fracture was introduced to describe these compression injuries by Destot in 1911. A pilon fractures is a complex intra‐articular fracture of the distal tibia. They result from axial forces that can range from low to high energy and produce a spectrum of articular and metaphyseal injuries pilot hole If a fully threaded screw is to function as a lag screw, it must be anchored near its tip, within a threaded hole in the far bone fragment. The original drill hole, which is made prior to tapping of the thread in the bone, is called the pilot hole. Within the bone fragment near the head of the screw, the thread should not obtain purchase but should allow gliding of the screw (glide hole) pin loosening The pins of external fixator frames serve to stabilize the fragments of a fracture by linking the bone to the frame. Stability depends, among other things, upon the contact between pin and bone (pin–bone interface). Pin loosening occurs when bone surface resorption at the pinbone interface takes place due to excessive cyclical loading of the bone. Stability is thereby reduced. However, pin loosening is less important in respect of loss of stability than in respect of its deleterious effect in promoting pin‐track infection pin‐track infection Are a complication of external fixation. Because pins (Schanz screws) pass through the skin into bone they form a potential passage for bacteria from the skin to migrate into the bone and cause a deep infection pitch Distance between turns of a screw thread pivot Is a pin, point, or short shaft on the end of which something rests and turns, or upon and about which something rotates or oscillates

plafond fracture Any fracture that involves the distal surface of the tibia that comes into contact with the dome of the talus plantar The word "plantar" is commonly understood in medical terminology as the bottom of the foot ‐ it translates as "toward the sole", i.e., the surface of the foot which is “planted” on the ground See illustration directions plantarflexion Plantarflexion (or plantar flexion) is the movement which increases the approximate 90 degree angle between the front part of the foot and the tibia, as when depressing an automobile pedal. Actually this movement is an extension and not a flexion. The correct anatomical‐functional expression would be „plantarextension“ The movement in the opposite direction is dorsiflexion, where the dorsal part (top) of the foot is moved in a manner towards the tibia See illustration directions plastic deformation Permanent deformation. See also elastic deformation platelet A type of blood cell that helps prevent bleeding by causing blood clots to form; thrombocyte plegia Suffix meaning paralysis or a stroke PMMA (polymethylmethacrylate) A polymer of methylmethacrylate, commonly used as a bone cement poller screw Poller screws (also called blocking screws) decrease the width of the medullary canal, forcing the nail to the center of the bone, thereby also increasing the mechanical stiffness of the bone‐ implant‐construct. Placed adjacent to the nail, poller screws are proposed as a possible solution to prevent lateral or medial translation in both the tibia and the femur. Poller screws can be used for: 1) alignment, 2) stabilization, and 3) manipulation. The screw is placed perpendicular to the direction in which the implant might displace polymethylmethacrylate (PMMA) A polymer of methylmethacrilate, commonly used as a bone cement polytrauma Multiple injury to one or more body systems or cavities. An Injury Severity Score (ISS) of more than 16 is usually taken to indicate polytrauma. The term however is generic, and has been in use for a long time for any case involving multiple traumata. Today there is still lack of a validated or consensus definition of the term polytrauma. The term should only be used in the case of life threatening conditions 55

position screw One which is inserted between two bones, or two bone fragments, having thread purchase in both so that the relative position of the two pieces of bone at the time of screw insertion is maintained. A position screw does not compress the bones together, but maintains their anatomical relationship posterior The back of the body in the anatomical position is the posterior surface. If A is nearer to the back of the body in the anatomical position than B, then A is posterior to B. Equivalent to dorsal, except in the foot, where the dorsum is anterior in the anatomical position—see dorsal See illustration directions postoperative after surgery prebending of plate Precise contouring of plates so that they fit perfectly onto the bone. To achieve stabilization against both torque and bending, compression at the far cortex is even more important than at the near cortex. To provide uniform compression across the whole width of the bone, including the far cortex, the plate is applied after contouring with an additional bend of the plate segment bridging the fracture. The bend is such that the midsection of the plate is slightly elevated from the surface of the reduced fracture, prior to fixation to the bone and the application of compression precise reduction See anatomical reduction preload The application of interfragmentary compression keeps the fragments together until a tensile force is applied, exceeding the compression (preload) preoperative before surgery primary bone healing Also called Haversian remodeling. Healing without callus under conditions of rigid fixation (absolute stability). See also direct bone healing See illustration direct bone healing prion Infectious agent composed of protein in a misfolded form. This is in contrast to all other known infectious agents, which must contain nucleic acids (either DNA, RNA, or both) along with protein components. Prions are not living organisms process A prominence or projection procurvatum In orthopedics procurvatum is a term for a deformity with anterior angulation of a bone or joint on the sagittal plane whereas the apex (peak) of the angle is forwards oriented. The deformity is also called flexion deformity. The opposite of procurvatum is recurvatum 56

pronation The movement of rotating the flexed forearm so that the palm of the hand faces downward. Pronation is also sometimes used to describe a movement of the foot into inclination away from the midline, otherwise called eversion; so that a pronated foot would bear more weight on its medial border than on its lateral border Illustration: forearm in pronation prone Positioned with the face down prophylactic Preventive prosthesis In orthopaedics: an artificial substitute for a joint, such as a hip, knee, shoulder or ankle joint protection An implant (plate, external fixator, or nail) which functions by virtue of its stiffness. The implant carries a major part of the functional load and thus diverts loads away from the fracture locus and may serve to protect a more vulnerable element of a fixation complex. An example is where a fracture has been reduced and fixed with interfragmentary (lag) screws, and then a plate is applied to protect the primary screw fixation from functional loads which could disrupt it. The use of such a protection, or “neutralization”, plate will allow earlier function aftercare than had the screw fixation been left unsupported. See neutralization and stress shielding Illustration: lag screw with protection plate proximal Nearer to the center of the body in the anatomical position. The opposite of distal. Thus, the elbow is proximal to the wrist. In certain instances, it means nearer the beginning than the end; for example, in the digestive system the stomach is proximal to the ileum, or in the urinary tract the kidney is proximal to the bladder See illustration directions pseudoarthrosis A false joint that results from a nonunion of a fracture; the term is often loosely and incorrectly used to describe all nonunions. Other forms of non‐unions are necrotic, hypertrophic or infective Illustration pseudoarthrosis distal humerus pure depression An articular fracture in which there is depression alone of the articular surface without split—see impacted fracture and pure split pure split An articular fracture in which there is a longitudinal metaphyseal and articular split, without any additional osteochondral lesion 57

q quadriplegia The loss of voluntary muscle, sensory and reflex functions of arms and legs. Synonymous: tetraplegia

r radial deviation Movement of the hand at the wrist toward the radius radial preload To prevent external fixator pin loosening, pins are designed with a thread and shank that automatically generate radial preload—a tight, compressive fit produced by insertion of a pin slightly larger than the drill hole. The effect of radial preload is to minimize pin loosening and to seal the pin track so that a potential infection cannot reach the medullary cavity from outside. radiation 1. Rays of energy. Gamma rays and X‐rays are two of the types of energy waves often used in medicine. 2. The use of energy waves to diagnose or treat diseases as cancer radiolucent Anything that permits the penetration and passage of X‐rays or other forms of radiation. Radiolucent is the opposite of radioopaque (which refers to anything that blocks the penetration of X‐rays) radiotherapy Treatment of pathological conditions, usually malignant, with ionizing radiation. It has been recommended in low dosage to discourage heterotopic bone formation radioopaque Preventing passage of radiant energy (x‐ray), thus causing the area to appear light or white on exposed film. Radioopaque is the opposite of radiolucent

recurvatum Opposite of procurvatum. In orthopedics recurvatum is a term for a deformity with posterior angulation of a bone or joint on the sagittal plane whereas the apex (peak) of the angle is backwards oriented. A genu recurvatum (illustration) is a deformity in the knee joint, so that the knee bends backwards. The deformity is also called extension deformity red blood cell A doughnut‐shaped blood cell that carries oxygen from the lungs to body tissues reduce Reposition back to its normal site reduction See fracture reduction reflex sympathetic dystrophy See fracture disease refracture A fracture occurring after the bone has solidly bridged, at a load level otherwise tolerated by normal bone. The resulting fracture line may coincide with the original fracture line, or it may be located remote from the original fracture, but within the area of bone that has undergone changes as a result of the fracture and its treatment regional pain syndrome (CRPS). See fracture disease relative stability An internal fixation construct that allows small amounts of motion in proportion to the load applied. The fracture heals with callus formation = secondary or indirect bone healing. This is the case with a fixation that depends exclusively on the stiffness of the implant (such as a nail, or a plate, bridging a multifragmentary fracture segment). See flexible fixation. Opposite: absolute stability remodeling (of bone): Permanent process by which old bone is actively removed by osteoclasts and replaced by osteoblast activity resorb to dissolve something and assimilate it reposition See fracture reduction resorption (of bone): The process of bone removal includes the dissolution of mineral and matrix and their uptake into the cell (phagocytosis). The cells responsible for this process are osteoclasts restoration of anatomy Restoring anatomical relations and fixation with relative stability: axis, length, rotation. Cave: restoring the anatomy or anatomical relations is not the same as anatomical reduction retrograde Moving or bending backwards. Opposite: antegrade

reversed Barton’s fracture is an intra‐articular fracture of the distal radius with volar displacement of the radiocarpal joint. (Intra‐articular Smith’s fracture) See also Colles’ fracture and Barton’s fracture rheumatism Rheumatism is an older term, used to describe any of a number of painful conditions of muscles, tendons, joints, and bones rigid fixation A fixation of a fracture which doesn’t allow movements or deformation under load—see absolute stability rigid implants In general implants are considered to be rigid when they are made of metals. The implant geometry is more important than the physical stiffness of the material. Most implants made of metal are much more flexible (less rigid) than the corresponding bone rigidity A biomechanical term that refers to a structure's ability to resist deformation. This term is often used synonymously with stiffness rotation Movement around an axis rupture A break or tear in any organ (such as the spleen) or soft tissue (such as the Achilles tendon)

s sagittal A vertical plane passing through the standing body from front to back. The mid‐ sagittal, or median, plane splits the body into left and right halves See illustration body planes sarcoma One of a group of tumors usually arising from connective tissue. Most sarcomas are malignant. Many types are named after the type of cell, tissue, or structure involved, as in angiosarcoma, chondrosarcoma, fibrosarcoma, liposarcoma, and osteosarcoma scarf test A test for acromio‐clavicular dysfunction: the patient experiences pain in the acromio‐clavicular joint when bringing the forward flexed arm across the front of their body, as if to “toss a scarf” over the opposite shoulder (this movement is called horizontal adduction)

Schatzker classification Classification system for tibia plateau fractures, types I ‐ VI scrub 1. As a verb, to wash the hands and forearms very thoroughly, as before engaging in surgery. To scrub implies the use of a brush (and often an implement to clean under the nails). To scrub, to scrub in (on a surgical procedure), and to scrub up are synonymous second look The practice, in open fracture treatment, following debridement, of surgically inspecting the injury zone again at 48–72 hours, to permit re‐evaluation of the tissue excision and to conduct further debridement if indicated secondary bone healing Bone healing with callus under conditions of relative stability. See also indirect bone healing See illustration callus segmental fracture If the shaft of a bone is broken at two levels, leaving a separate shaft segment between the two fracture sites, it is called a “segmental” fracture complex sensory Relating to sensation, to the perception of a stimulus and the voyage made by incoming (afferent) nerve impulses from the sense organs to the nerve centers sepsis Commonly called a "blood stream infection." The presence of bacteria (bacteraemia) or other infectious organisms or their toxins in the blood (septicemia) or in other tissue of the body. Sepsis may be associated with clinical symptoms of systemic (bodywide) illness, such as fever, chills, malaise (generally feeling "rotten"), low blood pressure, and mental status changes. Sepsis can be a serious situation, a life threatening disease calling for urgent and comprehensive care is a serious medical condition, resulting from the immune response to a severe infection septicemia is sepsis of the bloodstream caused by bacteraemia, which is the presence of bacteria in the bloodstream. The term septicemia is also used to refer to sepsis in general septum A word borrowed from the Latin "saeptum" meaning a "dividing wall or enclosure” 61

sequestrum A piece of dead bone lying alongside, but separated from, the osseous bed from which it came. It is formed when a section of bone is deprived of its blood supply and the natural processes create a cleavage between the dead and the living bone. A sequestrum may be aseptic (sterile), as, for example, beneath a plate when there has been massive periosteal stripping and then a plate with a high contact “footprint” applied, killing the underlying bone. This is especially seen if a plate has been applied to the cortex at the same time as a reamed intramedullary nail has been inserted. Infected sequestra are formed in chronic osteomyelitis sesamoid bones Any bone embedded within a tendon. The patella is an example shear A shearing force is one which tends to cause one segment of a body to slide upon another, as opposed to tensile forces, which tend to elongate, or shorten, a body shock A state of reduced tissue perfusion, usually due to a fall in intravascular pressure secondary to hypovolemia, overwhelming sepsis (gram‐negative shock, or “red” shock), or allergic anaphylaxis short bone A bone that is of approximately equal dimension in all directions. The bones of the wrist and ankle are examples simple (single) fracture A term used to characterize a single circumferential disruption of a diaphysis or metaphysis or a single disruption of an articular surface. Simple fractures of the diaphysis or metaphysis are spiral, oblique or transverse skeleton Supporting framework of the human body composed of 206 bones Smith’s fracture, also sometimes known as a reverse Colles’ fracture is a distal extra‐articular fracture of the radius in the forearm with volar (palmar) displacement of the wrist and hand. The injury is most commonly found after falling on to the back of the hand. See also Barton’s fracture and reversed Barton’s fracture spiral fractures result from a rotatory mechanism; on x‐rays, they are differentiated from oblique fractures by a component parallel to the long axis of bone in at least 1 view splinting Splints can be used for temporary or definite immobilization for several orthopaedic problems, including fractures; dislocations; injury of muscles, tendons, and ligaments; protection of vascular/nerve repairs; and postsurgical wound protection The splint may be external (plaster, external fixators) or internal (bridge plate, intramedullary nail). A splint always provides relative stability split depression: A combination of split and depression in an articular fracture— see pure split and pure depression 62

spontaneous fracture Spontaneous fractures occur in seemingly normal bone without adequate trauma. Spontaneous fracture occurs primarily in two distinct groups of patients: the very active young and the elderly. Researchers and clinicians have used several terms interchangeably for spontaneous fracture, including pathologic fracture, fragility fracture, compression fracture, or fatigue fracture. Among the most common causes of spontaneous fracture are osteoporosis (calcium deficiency and corticosteroid‐induced), malignancy, and overexposure to vitamin A spongy bone See cancellous bone spontaneous healing The healing pattern of a fracture without treatment. Solid healing is observed in most cases, but malunion frequently results. This is how animal fractures normally heal in the wild sprain Partial or complete tear of a ligament sprained ankle See ankle sprain stability of fixation This is characterized by the degree of residual motion at the fracture site after fixation (i.e., very little or no displacement between the fragments of the fracture). In technical terms, stability describes the tendency to revert to a condition of low energy, but this strict definition is not adhered to in the lingua franca of fracture surgery. See absolute stability and relative stability stainless steel Also referred to as “surgical steel”. 316L composition (62.5 % Iron + 17.6 % chromium + 14.5 % nickel + 2.8 % molybdenum + minor elemental additions) stem cell Stem cells are “generic" or undifferentiated cells found in all multi cellular organisms with the capacity to differentiate into one of the more than 200 specialized cell types stenosis A narrowing or constriction of the diameter of a bodily passage. See also istmus stiffness The resistance of a structure to deformation. Under a given load, the higher the stiffness of an implant the smaller its deformation, the smaller the displacement of the fracture fragments, and the lower the strain generated in the repair tissue. Excessive tissue strain can interfere with healing. The stiffness of a structure is expressed as its Young’s modulus of elasticity stiffness and geometrical properties The thickness of a structure affects deformability by its third power. Changes in geometry are, therefore, much more critical than changes in material properties ‐ a fact often overlooked by non‐engineers. Thus, if flexible fixation is a goal, it can be achieved more effectively and in a more controlled manner by small changes of implant dimension or/and design than by using a “less rigid” material strain Relative deformation of a material, for example, repair tissue. Motion at the fracture site in itself is not the important feature, but the resulting relative deformation, which is called strain of the healing tissues. As strain is a ratio (displacement of fragments divided by width of fracture gap), very high levels of strain may be present within small fracture gaps even under conditions where the displacement may not be perceptible

strain induction Tissue deformation ‐ among other things ‐ may result in induction of callus. This would be an example of a mechanically‐induced biological reaction. For those reactions triggered by strain, such as callus formation and bone surface resorption, the concept of a lower limit of strain, the minimum strain, is to be considered strain theory ‐ Perren: With a small fracture gap, any movement will result in a relatively large change in length (i.e. high strain). If this exceeds the strain tolerance of the tissue, healing will not take place. If a larger fracture gap is subject to the same movement, the relative change in length will be smaller (i.e. less strain) and, if the critical strain level is not exceeded, there will be normal tissue function and indirect healing by callus strain tolerance This determines the tolerance of the repair tissues to mechanical conditions. No tissue can be formed under conditions of strain which exceed the levels of strain at which the tissue will rupture because of excessive elongation. Above such a critical level, strain will disrupt the tissue once formed, or will prevent its formation. Some examples of strain tolerance: granulation tissue 100%; dense fibrous tissue 20%; cartilage 10%; bone 2% strength The ability to withstand load without structural failure. The strength of a material can be expressed as ultimate tensile strength, bending strength, or torsional strength stress Load over area stress concentration See stress riser stress fracture A fracture caused by repetitive stress, as may occur in sports, strenuous exercise, or heavy physical labor. Stress fractures are especially common in the metatarsal bones of foot, particularly in runners. Osteoporosis increases the possibility of stress fractures. Treatment is by rest, disuse, and sometimes splinting or casting to prevent reinjury during healing. Stress fractures are also called “fatigue fractures”

stress protection Stress protection is often used synonymously with stress shielding, i.e., in a purely mechanical sense. It is often used to characterize bone loss, implying a negative connotation to stress shielding stress riser In any body subject to deformation, stress will be generated within its material. If any part of the body is weaker than the rest, there will be a concentration of stress (high mean stress) at this place. If an implant is notched by inappropriate handling, the area of damage will act as a stress riser and produce the risk of fatigue failure with cyclical loading. If a hole is drilled in a bone and then left empty, this too will result in high mean stress and the risk of fracture. With the exception of the LC‐DCP, with its even strength, most plate holes represent weaker points on the plate than the solid sections between the plate holes: in a fixation with such a plate, where a screw hole has been left unfilled in the fracture zone, the empty hole acts as a stress riser and also produces the risk of fatigue failure, or bending under high functional load stress shielding 1. Stress shielding refers to the reduction in bone density (osteopenia) as a result of removal of normal stress from the bone by an implant (for instance, the femoral component of a hip prosthesis). This is because by Wolff's law, bone in a healthy person or animal will remodel in response to the loads it is placed under. Therefore, if the loading on a bone decreases, the bone will become less dense and weaker because there is no stimulus for continued remodeling that is required to maintain bone mass 2. When internal fixation relies upon screws and plates, the stability of the construct is achieved mainly by the interfragmentary compression exerted by the lag screws. Lag screw fixation alone is very stable, but generally provides little security under functional load. A plate providing protection (or neutralization) is therefore often added. The function of such a plate is to reduce the levels of peak load passing through the lag screw fixation. Protection is provided by virtue of the stiffness of the plate. The plate shields the fracture’s primary fixation with lag screws ‐ see neutralization and protection subchondral Beneath the cartilage subluxation Partial dislocation of a joint. A complete dislocation is a luxation Sudeck’s atrophy: One of the names given to algodystrophy. See fracture disease superior Literally, above, or better than. In the anatomical position, if A is higher than, or above, B, then A is superior to B. The opposite is inferior

supination The movement of rotating the flexed forearm that causes the palm of the hand to face upward. Supination is also sometimes used to describe a movement of the foot into inclination toward the midline, otherwise called inversion; a supinated foot would bear more weight on its lateral border than on its medial border. Illustration: forearm in supination supine Positioned with the face up surgical steel See stainless steel synthetic. Substances that are artificially produced and not of natural origin synovectomy Excision of the synovial membrane synovia (synovial fluid). A fluid within the joint capsule which assists in lubrication and nutrition of the joint synovial joint A joint formed by the articulation of two (or tree as in the ankle joint) bones, the ends of which are lined with hyaline cartilage and is surrounded by a capsule which is lined with synovium synovium A complex, highly permeable, and vascular tissue that lines the inner surface of joint capsules, bursae, tendons, and ligaments systemic Refers to any route for drug, or fluid, administration, other than via the gastrointestinal tract, and usually by injection

t T‐score Score utilized in setting up norms for standardized tests, e.g. for the definition of osteoporosis with a standard deviation of (>‐2.5) TAN Ti‐6Al‐7Nb alloy (titanium – aluminium – niobium) tendon A band of dense fibrous tissue connecting a muscle to a bone tendonitis Inflammation of a tendon tennis elbow A painful injury to the tendon that is attached to the outer part of the elbow due to repetitive twisting of the wrist or forearm which causes irritation and inflammation of the extensor tendon. This tendon 66

attaches to the lateral epicondyle of the humerus. The condition is therefore also known as lateral epicondylitis. Tennis is not the only culprit. Any action that involves repetitive twisting of the wrist or forearm such as using a screwdriver can lead to this injury tensile force Tensile force is a load that is applied to a material that acts away from the surface it is applied to. In other words it acts to pull the material or object apart or stretch the material it is acting on, a bit like stretching an elastic band

tension Is the magnitude of the pulling force It is the opposite of compression tension band An implant (wire or plate) functioning according to the tensionband principle: the bone absorbs compression, the implant absorbs tension. When the bone undergoes bending load, the implant, attached to the bone’s convex surface, resists the tensile force. The bone, especially the far cortex, is then dynamically compressed. The plate is able to resist very large amounts of tensile force, while the bone best resists compressive load terrible triad Posterior dislocation of the elbow joint with fracture of both the radial head and coronoid process, the so called ‘terrible triad’, is a complex and difficult‐to‐treat injury tetraplegia The loss of voluntary muscle, sensory and reflex functions of arms and legs. Synonymous: quadriplegia threaded hole See pilot hole torque Torque, also called moment or moment of force, is the tendency of a force to rotate an object about an axis, fulcrum, or pivot. Just as a force is a push or a pull, a torque can be thought of as a twist. As an example: torque is applied to drive home and tighten a screw. The moment is equal to the product of lever arm (in meters) and force (in Newtons) producing torsion and rotation about an axis (the unit of torque in Nm) toxins Poisonous chemicals. Some pathogenic organisms release powerful toxins when they multiply and some when they die trabecula (pl. trabeculae): A solid bony strut of cancellous bone. Literally, a small beam or bar 67

track Describes the path created surgically through tissues by the insertion of an external fixator pin. In that context, the word “track” should be used (in the sense of its meaning the mark, or trail, left by the passage of anything—Oxford English Dictionary) tract An anatomical structure comprising mixed tissues organized to serve a specific physiological function (spinothalamic tract, urinary tract, etc.). It is commonly misapplied in discussing external fixator pins—see track traction (pulling). Commonly used methods for indirect reduction transverse Perpendicular to the long axis of bone. Not the same as horizontal, which means parallel with the horizon. Thus, if the body were lying flat on its back (supine), horizontal would be the same as the coronal plane (see above), but if the body were standing, in the anatomical position, horizontal would be in the transverse plane. In other words, horizontal is always related to the horizon, whereas the anatomical planes (coronal, frontal, sagittal, transverse) always relate to the anatomical position transverse fracture Fracture of long bones perpendicular to the anatomical axis translation Displacement of one bone fragment in relation to another, usually at right angles to the long axis of the bone—see displacement Tscherne classification of closed fractures and soft‐tissue injury. Grade C0: Little or no soft‐ tissue injury. Grade CI: Superficial abrasion (shaded area) and mild to moderately severe fracture configuration. Grade CII: Deep, contaminated abrasion with local contusional damage to skin or muscle (shaded area) and moderately severe fracture configuration. Grade CIII: Extensive skin contusion or crushing or muscle destruction (shaded area) and severe fracture tubercle In anatomy, the term tubercle describes a round nodule, small eminence, or warty outgrowth found on bones or skin, or, in cases of tuberculosis, in the lungs tuberosity Prominence on a bone where tendons insert 68

tumor A tumor or tumour is the name for a neoplasm or a solid lesion formed by an abnormal growth of cells (termed neoplastic) which looks like a swelling. Tumor is not synonymous with cancer. A tumor can be benign, pre‐malignant or malignant, whereas cancer is by definition malignant

u ulnar deviation Movement of the hand at the wrist toward the ulna ultrasound High‐frequency sound waves. Ultrasound waves can be bounced off of tissues using special devices. The echoes are then converted into a picture called a sonogram. Ultrasound imaging, referred to as ultrasonography, allows physicians and patients to get an inside view of soft tissues and body cavities, without using invasive techniques unilateral Having, or relating to one side. Unilateral is as, for example, to bilateral (which means having, or relating to, two sides union If a fracture is fixed so that the bone functions as a single unit, then it has been surgically “united” (osteosynthesis); the bone is not, however, healed. Bone healing is a process initiated by fracture and continuing until the bone is restored to its final state by remodeling—this may take years. We speak loosely of a fracture being united, but this is not a discrete event. What we are saying is that a healing fracture has reached the point in the process of union when the experienced surgeon estimates that it can withstand normal functional loads for that patient. Union is, therefore, a judgment, usually based upon a synthesis of temporal, clinical, and imaging information. This calls into question the validity of “time to union”, which is reported in so much of the surgical literature as a parameter for the judgment of the comparative efficacy of different treatments

v valgus In orthopedics a valgus deformity is a term for the outward angulation of the distal segment of a bone or joint on the coronal plane. Deviation away from the midline in the anatomical position. Thus, genu valgum is a deformity at the knee where the lower leg is angled away from the midline (knock knee)

Vancouver classification Classification system for periprothetic fractures, type A, proximal to the tip of the prosthesis; B, around the tip of the prosthesis; C, well distal to the tip of the prosthesis varus In orthopedics a varus deformity is a term for the inward angulation of the distal segment of a bone or joint on the coronal plane. Thus, genu varum is a deformity at the knee where the lower leg is angled toward the midline (bow leg) See illustration valgus vascularity That property of a tissue which reflects the extent to which it has, or does not have, a blood supply. A tissue is said to be vascularized if its intrinsic network of blood vessels is connected to the main circulatory system. Blood vessels may be shut off temporarily from the circulatory system. If the connection to the main circulation is permanently interrupted, or if the vessels present are not functioning, e.g., obliterated by thrombosis, the tissue is said to be avascular, or devascularized. We consider a tissue to be non‐vascular if there are normally no functioning vessels, as in hyaline cartilage vascularized supplied with vessels ventral Pertaining to the front or anterior of any structure ventral decubitus lying on the stomach. The more popular term is prone vertical Upright, perpendicular to horizontal virus A virus is a small infectious agent that can replicate only inside the living cells of organisms. Viruses are not living organisms volar See palmar See illustration directions Volkmann’s canal Channels running perpendicular to haversian canals allowing blood vessels to travel from osteon to osteon Volkmann’s fracture Fracture of the posterior malleolus, leaving a triangular fragment of the posterior distal tibia, called Volkmann’s triangle

w wave plate If the central section of a plate is contoured to stand off the near cortex over a distance of several holes, it leaves a gap between the plate and the bone, which (a) preserves the biology of the underlying bone, (b) provides a space for the insertion of a bone graft, and (c) increases the stability because of the distance of the “waved” portion of the implant from the neutral axis of the shaft. Such plating is useful in non‐union treatment 70

Weber classification The (Danis‐)Weber classification system uses the position of the level of the fibular fracture in its relationship to the syndesmosis. Type A: fracture below the syndesmosis Type B: fracture at the level of the syndesmosis, Type C: fracture above the syndesmosis level whit tears of the syndesmotic ligaments wedge fracture Fracture complex with a third fragment in which, after reduction, there is some direct contact between the two main fragments—see butterfly fragment wite blood cell One of the cells the body makes to help fight infections. There are several types of white blood cells (leukocytes). The two most common types are the lymphocytes and neutrophils (also called polymorphonuclear leukocytes, PMNs, or "polys") Wolff's law A principle stating that bone responds dynamically to stress and strain by altering its internal architecture. Bone is built up were bone it is needed. “Form follows function” woven bone Bone in which the osteoid is laid down in a haphazard, disorganized arrangement, as in immature bone, fractures and in areas of excessive bone remodelling

x xenograft A graft of tissue from an individual of one species to a recipient (host) of another species x‐rays 1. High‐energy radiation with waves shorter than those of visible light. X‐rays possess the properties of penetrating most substances (to varying extents), of acting on a photographic film or plate (permitting radiography), and of causing a fluorescent screen to give off light (permitting fluoroscopy). In low doses X‐rays are used for making images that help to diagnose disease, and in high doses to treat cancer. Formerly called a Roentgen ray 2. An image obtained by means of X‐rays xenograft A surgical graft of tissue from one species to an unlike species (or genus or family). A graft from a baboon to a human is a xenograft

z zone of injury The entire volume of bone and soft tissue damaged by energy transfer during trauma